A 52 year‐old male with no significant medical history presented with sudden onset of severe sharp interscapular pain. On examination, temperature was 33.1°C, and the blood pressure was 211/138 mmHg. ECG showed normal sinus rhythm. Echocardiogram demonstrated moderate concentric left ventricular hypertrophy. CT chest revealed aortic intramural hematoma (IMH) extending from the aortic arch, just distal to the origin of the brachiocephalic artery, down to the abdominal aortal. There was no aortic dissection. Acute aortic IMH was diagnosed. Intravenous labetalol and nitroprusside were given. On the third hospitalization day, he experienced chest pain. Repeated chest CT revealed interval enlargement of intramural hematoma and propagation of hematoma involving the ascending aorta. He was treated with intravenous antihypertensive medications. His clinical symptoms and blood pressure improved. He was later treated with labetalol, lisinopril, hydralazine and clonidine patch. The patient was discharged and a physician appointment was arranged.
Patients with undiagnosed hypertension can present in many ways from asymptomatic condition to life threatening hypertensive emergencies such as acute coronary syndrome and acute decompensated heart failure. Undiagnosed hypertensive patients presenting with acute aortic IMH as an initial presentation is extremely rare. Hypertension is a common medical condition and if it is unrecognized or untreated, it may causes life threatening complications such as IMH. Patients with IMH often present clinically similar to those of acute aortic dissection (AD). CT scan, MRI or TEE are diagnostic imaging modalities. IMH can evolve unpredictably to resolution or progress to AD. As illustrated in this case, it is likely that he has long‐standing untreated hypertension resulting in IMH.
Massive public educational programs are needed to increase awareness among the public to undergo routine preventive health maintenance examinations at least every year to detect hypertension before the development of deadly complications such as IMH.
To cite this abstract:Anuwatworn A, Ahmed A, Cheriyath P, Alagona P. Acute Aortic Intramural Hematoma: A Rare Initial Presentation of Undiagnosed Hypertension. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 320. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/acute-aortic-intramural-hematoma-a-rare-initial-presentation-of-undiagnosed-hypertension/. Accessed April 1, 2020.