| BackgroundAortic intramural hematoma (IMH) is not a kind of common disease with a high mortality, recognized as a life-threatening aortic disease. It is difficult to start a prospective study due to the emergency nature of this disease. To our knowledge, there are so little studies about aortic intramural hematoma in China that parts of doctors have not correct understandings of this disease.ObjectiveReview the clinical manifestation, diagnosis method, misdiagnosis, risk factors, treatments and prognosis.MethodsAnalysis all of IMH patients admitted in our hospital from January2008to December2013. All of the data were gained from medical records and follow-up records. Compare the clinical presentation, diagnosis, therapy and prognosis between Stanford type A and type B IMH. The statistics were analyzed with SPSS16.0.ResultsThere were25IMHA patients and36IMHB patients. The mean age of IMHA and IMHB was59.00±9.15and60.19±11.12, respectively. The percent of male patients in the two types was about60.00%and72.22%, respectively. The percent of hypertension, hyperlipidemia, hyperglycemia, aortic disease were not different between two types. The percent of chest pain and back pain in IMHA group was higher than that of IMHB group, however, the incidence of abdominal pain in IMHA group was lower than that of IMHB group. The percent of hydropericardium and pleural effusion in IMHA group was higher than that of IMHB group. The misdiagnosis rate was8.00%and8.10%in IMHA and IMHB. There are no difference for in-hospital mortality between two groups, but the outward mortality in IMHA group are significantly higher than that of IMHB group (55.00%vs9.09%,p<0.0001). The overall mortality in IMHA group are also significantly higher than that of IMHB group (64.00%vs16.67%,p<0.0001). The outward mortality of medical treatment in IMHA was higher than that of IMHB (84.62%vs8%,p<0.0001). The overall mortality of medical treatment in IMHA was also higher than that of IMHB (88.89%vs17.86%, p<0.0001). The mortality between medical treatment and surgical treatment in IMHA group was88.89%and0.00%, respectively. The mortality between medical treatment and endovascular treatment in IMHB group was17.86%and12.5%, respectively. The patient who receieved the endovascular treatment died of a cerebral hemorrhage.Conclusion1. Aortic intramural hematoma occured frequently in male people, especially for the group of50to60years old. The great majority of IMH patients could complain of abrupt chest and back pain. Additionally, the untypical symptoms could easily cause misdiagnosis.2. It is difficult to distinguish IMHA and IMHB from symptoms and physical examination. The patient highly suspected to IMH should receive noninvasive imaging examination.3. IMHA is not safe, medication therapy is risky, even dangerous. It is better to receive surgery immediately.4. For IMHB patients, a dynamic monitoring to check inpatients’ full aortic CTA is recommended and for the pejorative patients the endovascular treatment should be taken actively. BackgroundBoth Aortic intramural hematoma (IMH) and aortic dissection (AD) are life-threatening aortic disease with high mortalities. To our knowledge, there are so little studies about IMHB and AB AD in China that parts of doctors easily misunderstand these two diseases.ObjectiveReview the general characteristics, diagnosis, misdiagnosis, treatmeatments and prognosis.MethodsAnalysis parts of type B aortic intramural hematoma (IMHB) and type B aortic dissection (ABAD) patients admitted in our hospital from Jaurnary2008to December2013. All of the data were gained from medical records and follow-up records. The statistics were analyzed with SPSS16.0.ResultsThere were36IMHB patients and270ABAD patients. The mean age of IMHB and ABAD was60.19±11.12and52.37±11.11, respectively. The percentage of male patients in IMHB groups was about72.22%and that of ABAD group was82.59%. The percent of hypertension, hyperglycemia, Marfan Syndrom, aortic disease were not different between two groups. The percent of hyperlipidemia and renal cyst in IMHB group was higher than that of ABAD group. The percent of chest pain, beck pain and abdominal pain were not different between two groups. The percent of mesenteric ischemia and limb ischemia in ABAD group was higher than that of IMHB group. The outward mortality of medical treatment in ABAD was higher than that of IMHB (8.00%vs52.34%,p<0.0001). The overall mortality of medical treatment in ABAD was also higher than that of IMHB (17.86%vs56.41%,p<0.0001). The mortality of endovascular surgery in IMHB was12.55%, the patient was died of cerebral hemorrhage. The mortality of endovascular surgery in ABAD was5.37%. The mortality was no different between endovascular surgery and medical treatment in IMHB group. However, for ABAD group, there are no difference for in-hospital mortality between medical treatment, endovascular and hybrid surgery, and the outward mortality of medical treatment was significantly higher than endovascular and hybrid (52.34%vs4.08%vs0.00%, p<.0001), and the overall mortality of medical treatment was also significantly higher than endovascular and hybrid (88.89%vs17.86%,p<0.0001).Conclusion1. IMHB and ABAD occured more frequently in male people, especially for the patient of50to60years old. The majority of the patients could complain of abrupt chest and back pain. The untypical symptoms could lead to misdiagnosis.2. It is difficult to distinguish IMHB and ABAD from symptoms and physical examination. The patient highly suspected to IMHB or ABAD should receive noninvasive imaging examination.3. For IMHB patients, a dynamic monitoring to check inpatients’ full aortic CTA is recommended and for the pejorative patients the endovascular treatment should be taken actively.4. ABAD is not safe, medication therapy is risky, even dangerous. It is better to receive endovascular surgery immediately. |
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