Aortic Intramural Hematoma

To the Editor: The Image in Clinical Medicine presented by Harris and Rosenbloom (June 26 issue) 1 clearly illustrates the presentation and clinical consequences of a penetrating atheromatous ulcer in the descending aorta. Typically, the clinical presentation may closely mimic that of aortic dissection, but aortic imaging reveals no evidence of an intimal tear and circumferential hemorrhage into the media caused by a breach in the integrity of intima. 2 This pathologic process is distinct from the process of intramural hemorrhage, which may precede frank dissection of the aorta. 3 Hemorrhage within the wall of the aorta occurs in these cases despite a . . .