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Should ascending aortic intramural hematoma be treated surgically?

      Aortic intramural hematoma (IMH) was first described by Krukenberg in 1920
      • Krukenberg E.
      Beitrage zur Frage des Aneurysma dissecans.
      and is characterized by the absence of an intimal tear and false lumen that are the main characteristics of classic aortic dissection. This variant form of aortic dissection can not be diagnosed by angiography.
      • Bansal R.C.
      • Chandrasekaran K.
      • Ayala K.
      • Smith D.
      Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography.
      Magnetic resonance imaging (MRI),
      • Amparo E.G.
      • Higgins C.B.
      • Hricak H.
      • Sollitto R.
      Aortic dissection magnetic resonance imaging.
      ,
      • Geisinger M.A.
      • Risius B.
      • O’Donell J.A.
      • Zelch M.G.
      • Moodie D.S.
      • Graor R.A.
      • George C.R.
      Thoracic aortic dissections magnetic resonance imaging.
      computed tomography (CT),
      • Thorsen M.K.
      • San Dretto M.A.
      • Lawson T.L.
      • Foley W.D.
      • Smith D.F.
      • Berland L.L.
      Dissecting aortic aneurysms accuracy of computed tomographic diagnosis.
      ,
      • Singh H.
      • Fitzgerald E.
      • Ruttley M.S.T.
      Computed tomography the investigation of choice for aortic dissection?.
      and transesophageal echocardiography (TEE)
      • Borner N.
      • Erbel R.
      • Braun B.
      • Henkel B.
      • Meyer J.
      • Rumpelt J.
      Diagnosis of aortic dissection by transeophageal echocardiography.
      ,
      • Ballal R.S.
      • Nanda N.C.
      • Gatewood R.
      • O’Arcy B.
      • Samdashi T.E.
      • Holman W.L.
      • Kirklin J.K.
      • Pacifico A.D.
      Usefulness of transesophageal echocardiography in assessment of aortic dissection.
      represent recent advances in the noninvasive diagnosis of aortic dissection. However, without recognition of this variant form of aortic dissection, one could erroneously make the diagnosis of aortic aneurysm with mural thrombus. Despite these challenging aspects of diagnosis, once the diagnosis is established, the recommended treatment strategy is not very different from classic aortic dissection. Surgical treatment has been recommended for type A and medical treatment for type B IMH.
      • Mohr-Kahaly S.
      • Erbel R.
      • Kearney P.
      • Puth M.
      • Meyer J.
      Aortic intramural hemorrhage visualized by transesophageal echocardiography findings and prognostic implications.
      ,
      • Nienaber C.A.
      • von Kodolitsch Y.
      • Petersen B.
      • Loose R.
      • Helmchen U.
      • Haverich A.
      • Spielmann R.P.
      Intramural hemorrhage of the thoracic aorta diagnostic and therapeutic implications.
      ,
      • Muluk S.C.
      • Kaufman J.A.
      • Torchiana D.F.
      • Gertler J.P.
      • Cambria R.P.
      Diagnosis and treatment of thoracic aortic intramural hematoma.
      ,
      • Harris K.M.
      • Braverman A.C.
      • Gutierrez F.R.
      • Barzilai B.
      • Davila-Roman V.G.
      Transesophageal echocardiographic and clinical features of aortic intramural hematoma.
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