Intramural Hematoma

Intramural hematoma (Figure 4.8) results from hemorrhage into the media from vasa vasorum or from a rupture of an atherosclerotic plaque18'19. This creates a layer of blood clot of varying thickness and varying consistency between the intima and adventitia. The systolic and diastolic force of blood on the vessel wall propels this clot to a varying degree. It can rupture in to the lumen of the aorta or outside through the adventitia. This could lead to either development of a classic dissection or penetrating ulcer by disrupting the internal elastic membrane or a rupture into the pericardial or pleural cavities by disrupting the external elastic membrane.

Figure 4.8. Composite picture demonstrates morphological and TEE short and long axis images of the aorta in a case of intramural hematoma. Note that the true lumen is completely obliterated slit-like appearance (black arrows) by the hematoma (white arrows) in the TEE images. Reprinted with permission.

Figure 4.8. Composite picture demonstrates morphological and TEE short and long axis images of the aorta in a case of intramural hematoma. Note that the true lumen is completely obliterated slit-like appearance (black arrows) by the hematoma (white arrows) in the TEE images. Reprinted with permission.

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