Sub-acute intramural haematoma of the ascending aorta

We report the case of an ascending aorta aneurysm with intramural haematoma (IMH) in a patient with severe hypotension without history of thoracic pain or hypertension. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) demonstrated the presence of subacute IMH and also revealed sacciform aneurysm of the aortic arch. The patient refused hospitalization and one week later he underwent emergency aortic replacement for dissection. CTA is the technique of choice in acute aortic syndrome and magnetic resonance is helpful in IMH detection and age determination. (C) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved