Penetrating Atherosclerotic Ulcer Causing Cardiac Tamponade — A Case Suggesting the Etiology of Intramural Hematoma

We report a case of penetrating atherosclerotic causing cardiac tamponade and subadventitial hematoma. A 72-year-old man was transferred with sudden onset of chest pain and a subsequent collapse. A computed tomography scan showed a pericardial effusion and a low density shadow around the ascending aorta. An emergency operation was conducted with a diagnosis of intramural hematoma complicating cardiac tamponade.The patient underwent replacement of the ascending aorta. The specimen of the ascending aorta showed severe atherosclerosis and no intramural hematoma. Histological evaluation revealed a hemorrhage which connected a small intimal ulcer to the subadventitial hematoma. We think this case suggest the entry oriented etiology of intramural hematoma not rupture of a vasa vasorum.