Intramural hematoma in acute aortic syndrome: more than one variant of dissection?

Intramural hematoma (IMH) of the aorta came onto the clinical horizon with its recognition as a variant of aortic dissection and with the early diagnostic use of modern tomographic imaging modalities in the evaluation of acute thoracic pain syndromes. IMH, which is a precursor of dissection, cannot be reliably distinguished from classic dissection on clinical grounds and is considered to represent about 10% to 20% of all cases of acute aortic syndromes. Other syndromes include symptomatic aneurysm, penetrating ulcerations, and dissection.