Aortic intramural hematoma (IMH) is an acute aortic syndrome with symptoms similar to those of aortic dissection. It is not a common diagnosis but is a potentially lethal disorder and IMH is sometimes considered as a lead up to classic aortic dissection, rupture or aneurysm. IMH weakens the aortic wall and may progress to either outward rupture of the aorta or inward, which results in aortic dissection. Intramural hematoma is where bleeding occurs within the aortic wall. Unlike aortic dissection, where the wall bursts, the collection builds up within the walls of the aorta. The symptoms though are hard to discern from those of aortic dissection, acute penetrating chest and back pain.


Short term prognosis is extremely serious in intramural hematomas involving the ascending aorta and surgical repair improves the outcome. Intramural hematoma of the descending aorta may be treated medically or surgically depending on clinical complications and imaging findings.