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Difference Between Intramural Hematoma and Dissection

Intramural hematoma is an aortic disease that is characterized by hemorrhage within the aortic wall and without a tear in the innermost intimal layer. Aortic dissection occurs when massive blood leakage occurs due to an intimal tear in the aorta. The tear causes the splitting or dissecting of the inner and middle layers of the aorta. Normal blood flow to other organs is compromised and eventually, aortic rupture may occur. Both these conditions fall under acute aortic syndrome.

What is intramural hematoma? 

Definition: When the blood leaks within the aortic wall without any tear, the condition is called an intramural hematoma. 

Causes and risk factors: Weakness of the aortic wall is the main cause of the development of an intramural hematoma. Conditions that can lead to this pathology include hypertension, atherosclerosis, traumatic chest injury, Marfan syndrome, turner syndrome, coarctation of the aorta, bicuspid aortic valve, cocaine use, and pregnancy. 

Symptoms: Symptoms of intramural hematoma often mimic those of aortic dissection. These include sudden onset of severe chest pain, severe back and abdominal pain, pain in the extremities, shortness of breath, heavy sweating, rapid weak pulse, and unconsciousness.  

Diagnosis: Early detection of intramural hematoma is important. Special diagnostic tests are used to detect aortic intramural hematoma if there is a suspicion of the disease. One of these tools is transesophageal echocardiography which detects the hematoma through sonography. Other tests include magnetic resonance angiogram (MRA), and CT angiogram.  

Treatment: Medications and immediate surgery is needed to treat the condition. Blood pressure control is achieved with medicines and the patient is stabilized before surgery. Surgery involves removing the damaged aortic tissue and replacing it with grafts.  

What is a Dissection? 

Definition: After an intimal tear in the aortic wall, blood fills up between the layers of the aorta causing a life-threatening condition called aortic dissection. 

Causes and risk factors: Aortic dissections occur after long-term, slow breakdown of aortic wall tissue. Certain conditions increase the risk of developing aortic dissection. These include collagen disorders such as Ehler-Danlos syndrome and Marfan syndrome, Turner syndrome, and hypertension. Men are at increased risk to develop aortic dissection. Increasing age is another risk factor for dissection. 

Symptoms: Classic symptoms of aortic dissection include a sudden severe, sharp pain in the chest that radiates to the back; it is described as tearing or stabbing in nature. Unequal blood pressure between the two arms is also seen in aortic dissection. Other symptoms include shortness of breath, nausea, vomiting, sweating, rapid fall in pulse, and unconsciousness.  

Diagnosis: Chest X-ray is not a very specific test but it can help in the diagnosis of aortic dissection. In stable patients, a CT angiogram is a preferred tool for the detection of dissection. Transthoracic and transesophageal echocardiograms give a better view of the vessel.  

Treatment: Medications are needed to keep the blood pressure in control. The mainstay treatment of serious aortic dissection is surgery. Techniques like graft replacement and endovascular stents are incorporated into the surgery.  

Differences between intramural hematoma and dissection

Definition:

Intramural hematoma is an aortic disease that results from hemorrhage within the aortic wall and without a tear in the innermost intimal layer. Aortic dissection occurs when massive blood leakage occurs due to an intimal tear in the aorta. 

Causes and risk factors:

Weakness of the aortic wall is the main cause of an intramural hematoma. Conditions that increase the risk of intramural hematoma include hypertension, atherosclerosis, traumatic chest injury, Marfan syndrome, turner syndrome, coarctation of the aorta, bicuspid aortic valve, cocaine use, and pregnancy. Conditions that increase the risk of developing aortic dissection include Ehler-Danlos syndrome, Marfan syndrome, Turner syndrome, and hypertension. Increasing age and male gender are other risk factors for dissection. 

Symptoms:

Symptoms of intramural hematoma include sudden onset of severe chest pain, severe back and abdominal pain, pain in the extremities, shortness of breath, heavy sweating, rapid weak pulse, and unconsciousness. Symptoms of aortic dissection include a sudden severe, sharp pain in the chest that radiates to the back which is tearing or stabbing in nature. Unequal blood pressure between the two arms is also seen in aortic dissection. Other symptoms include shortness of breath, nausea, vomiting, sweating, rapid fall in pulse, and unconsciousness.  

Diagnosis:

Transesophageal echocardiography, magnetic resonance angiogram, and CT angiogram are used to diagnose intramural hematomas. Chest X-ray, CT angiogram, and transthoracic or transesophageal echocardiograms are used to diagnose aortic dissection.  

Treatment:

Medications and surgery are needed to treat both disorders.  

Table of differences between intramural hematoma and dissection

FAQs:

Is an intramural hematoma a dissection?

Intramural hematoma is a contained hemorrhage in the vasa vasorum of the aorta. It does not have an intimal tear hence it is not an aortic dissection. An intramural hematoma is an atypical form of aortic dissection. 

How to treat an intramural hematoma?

Either surgery or medication is used to treat an intramural hematoma.

What can aortic dissection be mistaken for?

An aortic dissection is often mistaken for a heart attack. The sudden onset of sharp tearing chest pain that radiates to the back is typical for aortic dissection and is confused for myocardial infarction or angina pain.

Difference between intramural hematoma and aortic dissection? 

If the hemorrhage is within the walls of the aorta, it is called an intramural hematoma. Once an intimal tear occurs and blood starts leaking out, the condition is called aortic dissection.


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References :


[0]Alomari, Ihab B., et al. "Aortic intramural hematoma and its complications." Circulation 129.6 (2014): 711-716.

[1]Alomari, Ihab B., et al. "Aortic intramural hematoma and its complications." Circulation 129.6 (2014): 711-716.

[2]Song, J-K. “Diagnosis of aortic intramural haematoma.” Heart (British Cardiac Society) vol. 90,4 (2004): 368-71. doi:10.1136/hrt.2003.027607

[3]Nienaber, Christoph A., et al. "Aortic dissection." Nature reviews Disease primers 2.1 (2016): 1-18.

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