Intramural hematoma may occur as a primary event in hypertensive patients in whom there is a ruptured small vessel supplying the aorta (vasa vasorum) into the media or may be caused by a penetrating aortic ulcer. It represents a hematoma within the layers of the aorta, and it can be the precursor to aortic dissection.
Intramural hematoma also may develop as a result of blunt chest trauma with aortic wall injury. Intramural hematoma may be associated with pain or asymptomatic.
Penetrating aortic ulcer is an atherosclerotic plaque, which penetrates through the intima and into the aortic media. It may precipitate a true dissection or may rupture into the adventitia to form a pseudoaneurysm.
The typical patient with penetrating atheromatous aortic ulcer is elderly and has hypertension, hyperlipidemia, atherosclerosis, and back or chest pain. Classic aortic dissection and symptomatic thoracic aortic aneurysms are among possibilities in the differential diagnosis.
The penetrating aortic ulcer is frequently accompanied with intramural hematoma. Disease progresses from intimal plaque ulceration to media hematoma formation to adventitial saccular pseudoaneurysm formation and finally ruptures if there is penetration of all three layers.
The penetrating aortic ulcer may be associated with pain or asymptomatic.
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