Medical Treatment or Surgery for Type A Intramural Hematoma?

Abstract

Background: Type A intramural hematoma (IMH) is a cardiovascular emergency with high mortality and morbidity rates. Emergency surgery remains the preferred management option. Case Summary: A 50-year-old woman was admitted with a chief complaint of chest pain and evidence of aortic dissection in transthoracic echocardiography. Computed tomographic angiography (CTA) showed IMH from the aortic root to the suprarenal arteries. In the absence of high mortality risk factors, medical treatment and follow-up studies were chosen for this patient. CTA was repeated at 3-month intervals for 1 year, and by the end of this period the IMH was completely resolved. Why Beyond the Guidelines?: Guidelines recommend emergency surgical intervention for type A IMH. This report presents evidence of successful medical treatment for type A IMH. Discussion: This case report showed that medical management with follow-up imaging studies can be considered as the first option in selected patients with type A IMH. © 2025 The Authors