[Diagnosis and therapy of an intramural hematoma of the ascending aorta].

HISTORY AND CLINICAL FINDINGS

A 79 year-old female presented with severe chest pain and shortness of breath.

INVESTIGATIONS

The chest X-ray showed a widened mediastinum and a small left-sided pleural effusion. Transesophageal echocardiography demonstrated not only dilatation of the ascending aorta and aortic regurgitation but also an echo-poor crescentic seam within the aortic wall. Computed tomography identified this structure as an intramural hematoma.

TREATMENT AND COURSE

The aortic valve and the ascending aorta were replaced.

CONCLUSION

An intramural hematoma of the ascending aorta may be difficult to recognize but it is a life-threatening condition and should be treated by prompt surgical repair.