Meta-analysis of 143 reported cases of aortic intramural hematoma☆
Section snippets
Data sources
We performed an English language search of Medline from 1986 to November 1998 for studies with the keywords “aortic diseases,” “aorta AND hematoma,” and “intramural hematoma.” We also reviewed references from select case reports. Studies that did not provide sufficient individual patient data were excluded. We extracted data from 19 studies that contained 143 cases.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19
Data collection
Three reviewers (RM, PR, and PM) collected data using a
Results
In autopsy studies, IMH accounts for 5% to 13% of all patients with acute aortic syndromes20, 21, 22(Figure 1). Several prospective studies7, 19, 23 have documented IMH in 13% of patients admitted to hospital with clinical signs of aortic dissection. Other investigators have documented a slightly higher incidence. Vilacosta et al1 reported a 17% incidence of nontraumatic IMH in their study and Keren et al24 diagnosed IMH in 20% of patients with acute aortic syndromes.
A total of 143 cases of
Clinical presentation
Most of the patients in this analysis were men (61%). Fifty-three percent of the patients had hypertension. Most of the patients had chest and/or back pain (80%). A small percentage of patients (0.7%) were asymptomatic and the condition was only diagnosed at routine screening. Furthermore, 2% of patients had syncope in the absence of chest pain. Of the 8 patients who had traumatic IMHs, 6 cases were due to motor vehicle accidents and the remainder were due to intra-aortic balloon pumps
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This study was supported in part by the Women’s League for Medical Research, Albert Einstein Medical Center, Philadelphia, Pennsylvania.