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This case report describes a 76-year-old hypertensive male presenting with atypical chest pain who was diagnosed with Type B aortic intramural hematoma (IMH) via CT angiography and managed conservatively with strict blood pressure and heart rate control, guided by serial imaging. Follow-up imaging over 3 years demonstrated stability and progressive resolution of the hematoma with medical management alone.
Conservative management with imaging surveillance can be a viable strategy for Type B aortic IMH in select patients, avoiding the need for immediate surgical intervention.
Aortic intramural hematoma is a life-threatening condition within the spectrum of acute aortic syndromes and is often misdiagnosed. We present the case of a 76-year-old man who attended the Emergency Department with mild, atypical chest pain. Initial assessment and laboratory tests were reassuring, and a musculoskeletal cause was considered; however, high blood pressure and diagnostic uncertainty prompted computed tomography angiography. Imaging revealed type B aortic intramural hematoma. The patient was managed conservatively with strict control of blood pressure and heart rate and close imaging surveillance. Short-interval repeat computed tomography angiography demonstrated stability, supporting continued medical therapy. Over 3 years, the outcome was favorable with progressive resolution of the hematoma. This case highlights the importance of considering acute aortic pathology in older hypertensive patients with atypical pain, and it illustrates how imaging surveillance can guide safe conservative management.
