Abstract
A 70-year-old man complained of sudden-onset severe chest pain. Contrast-enhanced computed tomography (CT) scans indicated type A acute intramural hematoma (IMH) involving the right coronary artery (RCA). As shown in Panel A, the adventitia of the proximal RCA (arrow) was separated from the media and intima (i.e., “naked”) by the aortic IMH (double arrow, asterisk), giving the appearance that the RCA was penetrating the IMH (see Supplementary Panel A, available online). There was no malperfusion of the RCA and no ischemic changes on the electrocardiogram. The patient was managed with optimal antihypertensive and analgesic treatment without surgery in accordance with the Japanese guideline on the diagnosis and treatment of aortic aneurysm and aortic dissection. 1
On repeated CT scans 2 weeks later (Panel B), the IMH (asterisk) decreased and the proximal RCA (arrow) recovered most of its adventitia, which suggested that the adventitia was reattached (i.e., “clothed”) to the media and intima (see also Supplementary Panel B). Although the IMH compressed the aortic lumen and caused a mild change in the course of the RCA, both of these findings were improved on the follow-up imaging. The patient’s course was uneventful and he was discharged without complication and remains well 3 years later.
Intramural hematoma of the coronary artery is a rare complication in percutaneous coronary intervention 2 and also occurs spontaneously. 3 In the present case, aortic IMH extended to the proximal portion of the RCA, and the RCA without the adventitia appeared to penetrate the aortic IMH.
Supplemental Material
sj-tif-1-vmj-10.1177_1358863X241308208 – Supplemental material for Images in Vascular Medicine: Naked and clothed right coronary artery in aortic intramural hematoma
Supplemental material, sj-tif-1-vmj-10.1177_1358863X241308208 for Images in Vascular Medicine: Naked and clothed right coronary artery in aortic intramural hematoma by Hisato Takagi in Vascular Medicine
Supplemental Material
sj-tif-2-vmj-10.1177_1358863X241308208 – Supplemental material for Images in Vascular Medicine: Naked and clothed right coronary artery in aortic intramural hematoma
Supplemental material, sj-tif-2-vmj-10.1177_1358863X241308208 for Images in Vascular Medicine: Naked and clothed right coronary artery in aortic intramural hematoma by Hisato Takagi in Vascular Medicine
Footnotes
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Supplemental material
Supplemental material for this article is available online.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
