Publication:

Acute aortic intramural hematoma as a cause of acute abdominal pain: case report and review of literature

A middle aged male patient with sudden onset of severe upper abdominal pain was diagnosed as acute aortic intramural hematoma (IMH) by CT scan and treated conservatively in view of Type B IMH with prompt recovery. AAS (Acute Aortic Syndrome) needs to be considered in any acute abdominal pain, especially when the diagnosis is doubtful. There are three components of AAS namely aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), AD being more common.  Aortic dissection is primarily categorized by Stanford classification (Type A: involves the ascending aorta; Type B: involves only the descending aorta) or the more comprehensive DeBakey classification. It presents as sudden, severe, tearing chest or back pain,  requiring  immediate treatment. The IMH has similar symptoms and is also classified by Stanford into Type A and Type B. Type A may need surgical treatment, whereas Type B IMH may be managed conservatively. CT angiography is usually the investigation of choice.