CC BY 4.0 · Aorta (Stamford) 2020; 08(03): 074-075
DOI: 10.1055/s-0040-1713107
Case Report

Intramural Hematoma as Unexpected Complication of COVID-19 Infection

1   Cardiology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
Mariano Cefarelli
2   Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
Rossella Fattori
3   Cardiovascular Center, Marfan Center, Ospedali Riuniti Marche, Ancona, Italy
Marco Di Eusanio
2   Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
› Author Affiliations
Funding None.


Novel coronavirus disease-2019 (COVID-19) is an ominous infectious disease that seems capable to attack any organ system, leading in the most severe cases to patient death. COVID-19 has been associated with multiple cardiovascular complications of inflammatory and immune origin, leading to a wide spectrum of vascular damage, myocardial injury, stroke, and pulmonary obstruction. We report the case of a patient with COVID-19 infection who developed an acute aortic syndrome with the characteristics of aortic intramural hematoma.

Publication History

Received: 23 April 2020

Accepted: 11 May 2020

Article published online:
04 June 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Driggin E, Madhavan MV, Bikdeli B. et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Cardiol 2020; 75 (18) DOI: 10.1016/j.jacc.2020.03.031.
  • 2 Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020; 17 (05) 259-260
  • 3 Evangelista A, Mukherjee D, Mehta RH. , et al; International Registry of Aortic Dissection (IRAD) Investigators. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 2005; 111 (08) 1063-1070
  • 4 Akamatsu et al. Evaluation of aortic wall inflammation in acute aortic intramural hematoma using FDG-PET/CT in relation to prognostic aorta-related outcome. J Nucl Med 2017; 58 (01) 1167
  • 5 Kuehl H, Eggebrecht H, Boes T. et al. Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serological markers of inflammation. Heart 2008; 94 (11) 1472-1477
  • 6 Erbel R, Aboyans V, Boileau C. et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35 (41) 2873-2926
  • 7 Kitai T, Kaji S, Kim K. et al. Prognostic value of sustained elevated C-reactive protein levels in patients with acute aortic intramural hematoma. J Thorac Cardiovasc Surg 2014; 147 (01) 326-331
  • 8 He R, Guo DC, Estrera AL. et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg 2006; 131 (03) 671-678