The Healed and Sealed Aortic Intimomedial Tear

A retrospective study of surgical pathology and autopsy material revealed eight examples of intimomedial tears that had healed with the tear sealed or obliterated by fibromuscular tissue; four were the result of iatrogenic trauma related to application of aortic cross clamps during surgery and four developed spontaneously. The former were single lesions, the latter all associated with other intimomedial tears. Iatrogenic/traumatic tears occurred in ascending aortas that had histologically normal medias, spontaneous ones were located at sites where intimal tears are found and affected aortas with diseased medias. Observations in these cases suggest a triphasic process in the pathogenesis of dissecting aneurysms involving an intimal tear, hemorrhage into the resultant defect, and a hemorrhagic dissection of the media. These processes do not necessarily follow in sequence so the mechanism of each must be understood. The size and morphology of healed and sealed intimomedial tears indicate some might be detectable by ultrasonography and/or other imaging techniques. They seem uncommon but could be missed by both imagers and pathologists.