Aicher D, Graeter T, Langer F, Schäfers H J
Abteilung für Thorax- und Herz-Gefässchirurgie, Universitätskliniken des Saarlandes, Homburg.
Z Kardiol. 2000 Oct;89(10):965-8. doi: 10.1007/s003920070172.
Intramural hematoma is a spontaneous, localized bleeding in the wall of the thoracic aorta without evidence of intimal tear. Clinically, intramural hematoma manifests itself as an acute thoracical pain in patients with hypertension and therefore shows parallels with the classical aortic dissection. In the literature there is controversial discussion whether intramural hematoma can be regarded as its own aortic pathology or a precursor in the development of classical aortic dissection. We present the case of a 66 year old male who showed an intramural hematoma of the descending aorta which rapidly progressed to classical dissection within 3 months. This finding was secondarily accompanied by a dilatation of the descending aorta which leads to operative treatment with replacement of the proximal aorta descendens. This case supports the hypothesis that intramural hematoma is a potential early manifestation of aortic dissection and at the same time stresses the necessity for frequent follow-up investigations and, if necessary, early operative therapy.
壁内血肿是指胸主动脉壁内的自发性局限性出血，且无内膜撕裂证据。临床上，壁内血肿在高血压患者中表现为急性胸痛，因此与经典主动脉夹层相似。关于壁内血肿是否可被视为一种独立的主动脉病变或经典主动脉夹层发展过程中的前驱病变，文献中存在争议性讨论。我们报告一例66岁男性病例，该患者降主动脉出现壁内血肿，并在3个月内迅速发展为经典夹层。这一发现继而伴有降主动脉扩张，导致对近端降主动脉进行置换的手术治疗。该病例支持壁内血肿是主动脉夹层潜在早期表现的假说，同时强调了频繁随访检查以及必要时早期手术治疗的必要性。
