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Int J Angiol 2017; 26(04): 267-270
DOI: 10.1055/s-0037-1604333
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Precipitous Resolution of Type-A Intramural Hematoma with Medical Management in a Patient with Metastatic Stage 4 Renal Cell Carcinoma

Camilo A. Velasquez
1   Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Syed Usman Bin Mahmood
1   Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Mohammad A. Zafar
1   Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Adam J. Brownstein
1   Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Ayman Saeyeldin
1   Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
,
Bulat A. Ziganshin
1   Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
2   Department of Surgical Diseases 2, Kazan State Medical University, Kazan, Russia
,
John A. Elefteriades
1   Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
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Publikationsdatum:
24. August 2017 (online)

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Abstract

Intramural hematoma (IMH) is a variant form of aortic dissection characterized by involvement of the aortic media without the presence of an overt intimal flap. Surgical extirpation is the standard of care for type-A IMH in the Western world. However, a conservative approach with anti-impulse therapy has been advocated especially in Japan as a viable alternative. Here, we report a case of an elderly male patient with a history of metastatic stage 4 renal cell carcinoma who was treated with anti-impulse therapy for an acute type-A IMH. Blood pressure stabilization and continuous monitoring resulted in complete resolution of the IMH within 6 days. This report illustrates how immediate medical management in patients with acute type-A IMH who are not surgical candidates can alleviate the progression or even lead to regression as early as 1 week after initiating anti-impulse therapy.

Keywords

dissection - dissecting aneurysm - hematoma - intramural hematoma - medical therapy - resolution - type-A dissection
 

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