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.