Small Intramural Hematoma in the Aortic Root: What You Need to Know

Small hematoma in the anterior wall of the aortic root?

The CT scan of the chest with CTA revealed focal wall thickening in the anterior wall of the aortic root, with differential diagnoses including intramural hematoma and motion artifact.
The suspected lesion was consistently observed in the pre-contrast study.
No definite intimal flap was detected in the ascending and descending aorta.
Both lungs were normally aerated, and there were no signs of pleural thickening or fluid collection.
The mediastinum appeared normal without abnormal lymphadenopathy.
The heart was orthotopic with a normal configuration, and the cardiac chambers were of normal size.
Major intrathoracic vessels and the imaged portions of the supra-aortic vessels were unremarkable.
The thoracic skeleton and soft tissues showed no abnormalities, and there were no definite enhanced lesions in the liver, pancreas, spleen, or kidneys.
The report concluded with a suspected small intramural hematoma at the anterior wall of the aortic root, recommending echocardiography for follow-up.
There was no definite evidence of aortic dissection.
Regarding the echocardiography results, the findings indicate normal cardiac chamber sizes, normal wall thickness, preserved left ventricular contractility, and mild mitral and tricuspid regurgitation.

As for the exercise stress test showing positive ischemia, treatment options depend on the severity of the ischemia and symptoms.
It may not necessarily require hospitalization or surgery, but further evaluation by a cardiologist is essential to determine the appropriate management plan, which may include medication, lifestyle changes, or possibly invasive procedures if indicated.

Liao Wen-kai, 30~39 year old female. Ask Date: 2021/07/16

Dr. He Dongjin reply Cardiology

Hello, the CT scan and echocardiogram did not show any significant abnormalities, which may be due to artifacts.
Without reviewing the report of the exercise electrocardiogram, I cannot make a definitive statement.
Theoretically, a positive exercise electrocardiogram may indicate myocardial ischemia.
There is no need for hospitalization or surgery unless there are symptoms of angina.
Further evaluation, such as coronary angiography, may be recommended.
Changhua Hospital cares about your well-being.

Reply Date: 2021/07/16

More Info

Understanding a small intramural hematoma in the aortic root can be quite concerning, especially given the potential implications for cardiovascular health. An intramural hematoma refers to a localized collection of blood within the wall of a blood vessel, in this case, the aorta. It can arise due to various reasons, including trauma, hypertension, or spontaneous rupture of atherosclerotic plaques.
In your CT scan report, the findings indicate a focal wall thickening in the anterior wall of the aortic root, which is suspected to be an intramural hematoma. Importantly, the report notes that there is no evidence of an intimal flap, which is a critical feature that would indicate a more severe condition known as aortic dissection. Aortic dissection is a life-threatening condition where the inner layer of the aorta tears, allowing blood to flow between the layers of the aortic wall. The absence of an intimal flap is reassuring, suggesting that the situation may not be as dire as it could be.

The recommendation for follow-up with echocardiography is standard practice. An echocardiogram can provide additional information about the structure and function of the heart and aorta, helping to assess the size and impact of the hematoma. It can also evaluate the heart's contractility and any potential effects on blood flow.

Regarding the severity of the condition, a small intramural hematoma may not always require surgical intervention, especially if it is stable and not causing significant obstruction or other complications. However, close monitoring is essential. The echocardiogram will help determine if there are any changes in the size of the hematoma or if it is affecting heart function.

Your echocardiogram results indicate normal cardiac chamber sizes, normal wall thickness, and preserved left ventricular contractility, which are positive signs. Mild mitral and tricuspid regurgitation noted in the report are common findings and may not be clinically significant, especially if they are mild.
As for the exercise stress test showing positive ischemia, this is a separate concern that may require further evaluation. Ischemia indicates that the heart muscle is not receiving enough blood flow, which could be due to coronary artery disease or other cardiovascular issues. Depending on the severity and the symptoms you experience, your doctor may recommend lifestyle changes, medications, or possibly further diagnostic tests such as a coronary angiogram to assess the coronary arteries.

In summary, while a small intramural hematoma in the aortic root can be serious, the absence of an intimal flap and the normal findings on your echocardiogram are encouraging. It is crucial to follow up with your healthcare provider for ongoing monitoring and to address any concerns regarding ischemia. Treatment decisions will depend on the overall clinical picture, including symptoms, risk factors, and the results of further tests. Always consult with your healthcare provider for personalized advice and treatment options.

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