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Eur J Cardiothorac Surg 1999;15:108-109
© 1999 Elsevier Science NL

Images in cardio-thoracic surgery

Aortic dissection limited to the ascending aorta mimicking intramural hematoma

Clinic for Thoracic and Cardiovascular Surgery, University Hospital, CH-3010 Berne, Switzerland

Received 6 October 1998; received in revised form 12 October 1998; accepted 12 October 1998.

Corresponding author. Tel.: +41-31-632-2376; fax: +41-31-382-0279; e-mail: thierry.carrel@insel.ch

Intramural hematoma of the thoracic aorta has emerged as a diagnosis of exclusion in recent years. Significant overlap with acute aortic dissection exists despite the increased sensitivity of preoperative CT-scan, transesophageal echocardiography (TEE) or magnetic resonance imaging. Surgical treatment has been recommended when the ascending aorta is involved. This 74-year-old patient was admitted with acute chest pain and chest X-ray showed an enlarged mediastinum. CT scan and TEE demonstrated a large intramural hematoma of the ascending aorta but did not show any intimal flap (Fig. 1). However, an acute dissection limited to the ascending aorta was found intraoperatively with the intimal tear located above the left coronary ostium (Figs. 2 and 3). Supracoronary graft replacement of the ascending aorta was performed immediately, using deep hypothermic cardiopulmonary bypass and a brief period of circulatory arrest for the confection of the distal anastomosis. The patient recovered well and was discharged 2 weeks following surgery.

View larger version (118K): [in this window] [in a new window]   Fig. 1. CT scan showing the large intramural hematoma of the ascending aorta.

View larger version (122K): [in this window] [in a new window]   Fig. 2. Intraoperative view of the ascending aorta after sternotomy.

View larger version (101K): [in this window] [in a new window]   Fig. 3. Intimal tear located above the left coronary ostium (arrowhead) and typical finding of a thrombosed false channel (small arrow: intima-media layers, large arrow: aortic adventitia).

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berdat, P.A. Articles by Carrel, T. Search for Related Content PubMed PubMed Citation Articles by Berdat, P.A. Articles by Carrel, T.