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Aortitis Masquerading as Intramural Hematoma: When to Observe, When to Operate? A Case Report
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  • Ana Velez,
  • Eric Etchill,
  • Marc Halushka,
  • Stefano Schena
Ana Velez
Johns Hopkins University School of Medicine
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Eric Etchill
Johns Hopkins University School of Medicine
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Marc Halushka
Johns Hopkins University School of Medicine
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Stefano Schena
Johns Hopkins University School of Medicine
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Abstract

Radiologic evidence of aortic disease is not always consistent with the diagnosis. With lack of accompanying symptoms or with an atypical presentation, diagnosis of aortic pathology relies greatly on imaging techniques. We report the case of a 58 year-old female who presented with incidental radiographic findings consistent with a type A aortic intramural hematoma and a vague left-sided chest discomfort. After follow-up imaging was consistent with disease progression and hematoma expansion, the affected segment was resected and pathology reported lymphoplasmacytic aortitis as the underlying etiology of the imaging findings rather than an intramural hematoma. The patient lacked symptoms or serology consistent with rheumatologic disease and the postoperative course was uneventful. The management of a suspected ascending intramural hematoma is controversial, especially when the patient presents with atypical signs and symptoms. Features of disease progression may warrant urgent surgical intervention.

Peer review status:ACCEPTED

19 Oct 2020Submitted to Journal of Cardiac Surgery
21 Oct 2020Submission Checks Completed
21 Oct 2020Assigned to Editor
09 Dec 2020Reviewer(s) Assigned
21 Dec 2020Review(s) Completed, Editorial Evaluation Pending
22 Dec 2020Editorial Decision: Revise Minor
07 Jan 20211st Revision Received
07 Jan 2021Submission Checks Completed
07 Jan 2021Assigned to Editor
07 Jan 2021Reviewer(s) Assigned
08 Jan 2021Review(s) Completed, Editorial Evaluation Pending
08 Jan 2021Editorial Decision: Accept