Yu Yun, Fei Aihua, Wu Zengbin, Wang Hairong, Pan Shuming
Department of Emergency, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Intractable Rare Dis Res. 2017 May;6(2):87-94. doi: 10.5582/irdr.2017.01011.
Aortic intramural hemorrhage (IMH) is one of the disease processes that comprise the spectrum of acute aortic syndrome (AAS) with clinical manifestations and a mortality rate similar to those of classic aortic dissection (AD). However, IMH should be considered as a distinct disease entity rather than a precursor to classic dissection because of differences in their pathology, etiology, natural history, and imaging findings. Multidetector computed tomography (CT) is recommended as the first-line diagnostic imaging modality for IMH, but transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) are also helpful. There is still debate over the appropriate treatment of IMH. Medical treatment of type B IMH appears effective and safe, while surgical treatment is recommended for type A IMH. Thoracic endovascular aortic repair (TEVAR) is a promising treatment for selected patients, and more clinical evidence needs to be assembled.
主动脉壁内血肿（IMH）是构成急性主动脉综合征（AAS）谱的疾病过程之一，其临床表现和死亡率与经典主动脉夹层（AD）相似。然而，由于IMH与经典夹层在病理、病因、自然史和影像学表现上存在差异，应将其视为一种独特的疾病实体，而非经典夹层的前驱病变。多排螺旋计算机断层扫描（CT）被推荐为IMH的一线诊断成像方式，但经食管超声心动图（TEE）和磁共振成像（MRI）也有帮助。IMH的恰当治疗仍存在争议。B型IMH的药物治疗似乎有效且安全，而A型IMH则推荐手术治疗。胸主动脉腔内修复术（TEVAR）对部分患者是一种有前景的治疗方法，还需要收集更多临床证据。
