<- Home <- Arhive <- Vol. 31, Issue 1, March 2023



Rom J Leg Med31(1)5-11(2023)
DOI:10.4323/rjlm.2023.5
© Romanian Society of Legal Medicine


CLASSIC AORTIC DISSECTION OR INTRAMURAL HEMATOMA – A DELICATE FRONTIER

G. Tinica, M. Enache, A. Tarus, B. G. Ioan, B. Hanganu, V. Mocanu, R. V. Lupusoru, D. Butcovan,


Abstract: Introduction. The diagnosis of thoracic ascending aortic dissection (TAAD) can be challenging due to its varied presentation, including classic aortic dissection (CAD) and intramural hematoma (IMH). This study aimed to analyze the pathological features of TAAD in people with classical CAD or IMH at the time of diagnosis, taking in consideration the involvement of vasa vasorum (VV).
Material and method. We present 10 selected cases of TAAD identified in 5 patients with CAD and 5 ones with IMH. The patient’s risk factors (RFs) were studied in association with aortic lesions, dissection plane or VV changes, and analyzed using histological, immunohistochemical and morphometrical methods.
Results. Biopsies from 10 TAAD patients subjected to aortic surgery (5 with CAD and 5 with IMH) were analyzed according to severity of aortic wall changes. The mean age was of 61±4 in IMH patients and 47±8 years in patients with CAD. In CAD group, the patients had hypertension (n=5) and AAE (n=3), in association with moderate (n=3) to severe medial degeneration (n=2). In IMH group, the main histopathologic findings were mild to medial degeneration (n=2) and ATS (n=3), in association with BAV (n=2). Five patients with AAE (3) and BAV (2) developed ascending aortic aneurysm with a relatively large diameter (average diameter was < 5 cm).
Conclusions. We showed the characteristic morphological aortic changes, including dissection and VV plane analysis, in association with AAE, BAV and RFs. CMD was the most common aortic lesion in CAD, while in IMH group, ATS was the most common
Keywords: classic aortic dissection, aortic intramural hematoma, acute aortic syndrome.



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