J Korean Endocr Soc.  2009 Sep;24(3):217-220. 10.3803/jkes.2009.24.3.217.

Aortic Intramural Hematoma Associated with Primary Aldosteronism

• Chung JO
• Cho DH
• Chung DJ
• Chung MY

• KMID: 2178186
• DOI: http://doi.org/10.3803/jkes.2009.24.3.217

Abstract

Intramural hematoma of the aorta is a variant of aortic dissection characterized by the absence of direct communication between the false lumen and the true lumen of the aorta. Primary aldosteronism, which is an uncommon cause of hypertension, may direct alter arterial structure through the pleiotropic effects of aldosterone as well as pressure-mediated indirect alterations. There have been several reported cases of aortic dissection in patients with primary aldosteronism, which suggests a causal relationship between the two diagnostic entities. However, intramural hematoma has not been described in a patient with primary aldosteronism. We describe a case of aortic intramural hematoma in a patient with primary aldosteronism and speculate about the causal relationship between these two entities.

Keyword

aorta; hematoma; hyperaldosteronism

MeSH Terms

Aldosterone
Aorta
Hematoma
Humans
Hyperaldosteronism
Hypertension
Aldosterone

Figure

• 

  Fig. 1 Computerized tomography of the chest revealed a crescentic intramural hematoma (arrow) at the level of the aortic arch (A) extending into the infrarenal area (B).

• 

  Fig. 2 Computerized tomography of the abdomen showed a 1.1 × 1.1 cm sized mass (arrow) with homogeneous attenuation in the right adrenal gland (A, non-enhancement; B, enhancement). Non-enhanced images also revealed an intramural hematoma (arrowhead) with crescentic high attenuation in the abdominal aorta.

Reference

1. Maraj R, Rerkpattanapipat P, Jacobs LE, Makornwattana P, Kotler MN. Meta-analysis of 143 reported cases of aortic intramural hematoma. Am J Cardiol. 2000. 86:664–668.

2. Rossi GP, Pessina AC, Heagerty AM. Primary aldosteronism: an update on screening, diagnosis and treatment. J Hypertens. 2008. 26:613–621.

3. Rocha R, Stier CT Jr. Pathophysiological effects of aldosterone in cardiovascular tissues. Trends Endocrinol Metab. 2001. 12:308–314.

4. Ahmed SH, Husain NM, Khawaja SN, Massey CV, Pettyjohn FS. Is primary hyperaldosteronism a risk factor for aortic dissection? Cardiology. 2007. 108:48–50.

5. Tartière JM, Kesri L, Mourad JJ, Safar M, Blacher J. Primary aldosteronism. A risk factor for aortic dissection. J Mal Vasc. 2003. 28:185–189.

6. Mészáros I, Mórocz J, Szlávi J, Schmidt J, Tornóci L, Nagy L, Szép L. Epidemiology and clinicopathology of aortic dissection. Chest. 2000. 117:1271–1278.

7. Sawhney NS, DeMaria AN, Blanchard DG. Aortic intramural hematoma: an increasingly recognized and potentially fatal entity. Chest. 2001. 120:1340–1346.

8. Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, Fattori R, Cooper JV, Smith DE, Oh JK, Hutchison S, Sechtem U, Isselbacher EM, Nienaber CA, Pape LA, Eagle KA. International Registry of Aortic Dissection (IRAD) Investigators. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation. 2005. 111:1063–1070.

9. Shimizu H, Yoshino H, Udagawa H, Watanuki A, Yano K, Ide H, Sudo K, Ishikawa K. Prognosis of aortic intramural hemorrhage compared with classic aortic dissection. Am J Cardiol. 2000. 85:792–795.

10. Uchida K, Imoto K, Takahashi M, Suzuki S, Isoda S, Sugiyama M, Kondo J, Takanashi Y. Pathologic characteristics and surgical indications of superacute type A intramural hematoma. Ann Thorac Surg. 2005. 79:1518–1521.

11. Sun Y. The renin-angiotensin-aldosterone system and vascular remodeling. Congest Heart Fail. 2002. 8:11–16.

12. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, Rakowski H, Struyven J, Radegran K, Sechtem U, Taylor J, Zollikofer C, Klein WW, Mulder B, Providencia LA. Task Force on Aortic Dissection. European Society of Cardiology. Diagnosis and management of aortic dissection. Eur Heart J. 2001. 22:1642–1681.

13. Rossi G, Boscaro M, Ronconi V, Funder JW. Aldosterone as a cardiovascular risk factor. Trends Endocrinol Metab. 2005. 16:104–107.

14. Rossi GP, Belfiore A, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Palumbo G, Rizzoni D, Rossi E, Agabiti-Rosei E, Pessina AC, Mantero F. Primary Aldosteronism Prevalence in Italy Study Investigators. Comparison of the captopril and the saline infusion test for excluding aldosterone-producing adenoma. Hypertension. 2007. 50:424–431.

15. Brown JJ, Davies DL, Ferriss JB, Fraser R, Haywood E, Lever AF, Robertson JI. Comparison of surgery and prolonged spironolactone therapy in patients with hypertension, aldosterone excess, and low plasma renin. Br Med J. 1972. 2:729–734.

16. Ferriss JB, Beevers DG, Boddy K, Brown JJ, Davies DL, Fraser R, Kremer D, Lever AF, Robertson JI. The treatment of low-renin ("primary") hyperaldosteronism. Am Heart J. 1978. 96:97–109.

17. Ghose RP, Hall PM, Bravo EL. Medical management of aldosterone-producing adenomas. Ann Intern Med. 1999. 131:105–108.