Aortic Intramural Hematomas and Penetrating Aortic Ulcerations
PAU and IMH are distinct entities from aortic dissection, although they carry a significant risk of progression into dissection, aneurysm, and rupture - Tony Shao
HWN Suggests
Aortic Intramural Hematomas and Penetrating Aortic Ulcerations: Indications for Treatment Versus Surveillance
PAUs and IMHs are often seen together or in conjunction with acute aortic dissection. When diagnosed in the symptomatic patient, these complex aortic pathologies represent a potentially life-threatening medical condition. Prompt identification, medical management, and patient selection for intervention are critical components of care, along with long-term surveillance.
Articles of Interest
Intramural hematoma and penetrating ulcer in the descending aorta: differences and similarities
Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. Intramural hematoma (IMH), penetrating atherosclerotic ulcer (PAU), and aortic dissection can occur as isolated processes or can be found in association.
Pathogenesis in Acute Aortic Syndromes: Aortic Dissection, Intramural Hematoma, and Penetrating Atherosclerotic Aortic Ulcer
The classic aortic dissection involves an intimomedial flap, which traverses the aortic lumen. Intramural hematoma and penetrating aortic ulcer are nonflap lesions, with intramural hematoma showing no intimal disruption and penetrating aortic ulcer showing an ulcer at the atherosclerotic plaque burrowing through the aortic intima and media.
Penetrating aortic ulcer and aortic intramural hematoma: Treatment strategy
PAU and IMH are distinct entities from aortic dissection, although they carry a significant risk of progression into dissection, aneurysm, and rupture. PAU and IMH originating in zone 0 of the aorta generally require surgical treatment. When the origin is beyond zone 0, a trial of medical therapy is recommended.
