Kevin M. Harris, MDa, Alan C. Braverman, MDa, Fernando R

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Presentation transcript:

Transesophageal echocardiographic and clinical features of aortic intramural hematoma Kevin M. Harris, MDa, Alan C. Braverman, MDa, Fernando R. Gutierrez, MDb, Benico Barzilai, MDa, Víctor G. Dávila-Román, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 114, Issue 4, Pages 619-626 (October 1997) DOI: 10.1016/S0022-5223(97)70052-7 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 Short-axis TEE view of descending aorta at site of measurements. Left, TEE from patient with IMH. Right, Normal aorta. Aortic lumen measurements are indicated in major-axis diameter (a) and minor-axis diameter (b). Aortic wall thickness is indicated by c. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 TEE features of patients with IMH. a, IMH of descending aorta. There is marked focal wall thickening (1.4 cm), and wall thickness ratio is 4.7. b and c, Eccentric IMH causes crescent-shaped deformity of aortic lumen. Aortic lumen major/minor axis ratio is 1.6 in b. Note echolucent areas within the hematoma and displaced intimal calcium in b and c. d, Atherosclerotic plaque associated with an ulcer and IMH. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 TEE features of patients with IMH. a, IMH of descending aorta. There is marked focal wall thickening (1.4 cm), and wall thickness ratio is 4.7. b and c, Eccentric IMH causes crescent-shaped deformity of aortic lumen. Aortic lumen major/minor axis ratio is 1.6 in b. Note echolucent areas within the hematoma and displaced intimal calcium in b and c. d, Atherosclerotic plaque associated with an ulcer and IMH. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 TEE features of patients with IMH. a, IMH of descending aorta. There is marked focal wall thickening (1.4 cm), and wall thickness ratio is 4.7. b and c, Eccentric IMH causes crescent-shaped deformity of aortic lumen. Aortic lumen major/minor axis ratio is 1.6 in b. Note echolucent areas within the hematoma and displaced intimal calcium in b and c. d, Atherosclerotic plaque associated with an ulcer and IMH. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 TEE features of patients with IMH. a, IMH of descending aorta. There is marked focal wall thickening (1.4 cm), and wall thickness ratio is 4.7. b and c, Eccentric IMH causes crescent-shaped deformity of aortic lumen. Aortic lumen major/minor axis ratio is 1.6 in b. Note echolucent areas within the hematoma and displaced intimal calcium in b and c. d, Atherosclerotic plaque associated with an ulcer and IMH. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 Corresponding MRI (sagittal view) (left) and TEE (longitudinal view) (right) features in a patient with involvement of the ascending aorta with IMH. Involvement of the anterior wall of the ascending aorta is noted by arrows. AA, Ascending aorta; RPA, right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 MRI (left) and TEE (right) images of a patient with involvement of both the ascending and descending aorta. Upper right TEE image shows focal thickening of ascending aorta. Lower right images show crescent-shaped IMH (which is thicker than ascending segment) compressing the aortic lumen. The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 Transverse TEE image of an intraluminal thrombus within an aneurysm in the descending thoracic aorta. In contrast to intramural hematoma (Figs. 1 to 4), note that the thrombus (arrowheads) lies superior to the intimal calcium (arrows). The Journal of Thoracic and Cardiovascular Surgery 1997 114, 619-626DOI: (10.1016/S0022-5223(97)70052-7) Copyright © 1997 Mosby, Inc. Terms and Conditions