This review article is written so as to present the pathophysiology, the 
symptomatology and the ways of diagnosis and treatment of a rather rare aortic 
disease called Intra-Mural Haematoma (IMH). Intramural haematoma is a quite 
uncommon but potentially lethal aortic disease that can strike as a primary 
occurrence in hypertensive and atherosclerotic patients to whom there is 
spontaneous bleeding from vasa vasorum into the aortic wall (media) or less 
frequently, as the evolution of a penetrating atherosclerotic ulcer (PAU). IMH 
displays a typical of dissection progress, and could be considered as a 
precursor of classic aortic dissection. IMH enfeebles the aortic wall and may 
progress to either outward rupture of the aorta or inward disruption of the 
intima layer, which ultimately results in aortic dissection. Chest and back 
acute penetrating pain is the most commonly noticed symptom at patients with 
IMH. Apart from a transesophageal echocardiography (TEE), a tomographic imaging 
such as a chest computed tomography (CT), a magnetic resonance (MRI) and most 
lately a multy detector computed tomography (MDCT) can ensure a quick and 
accurate diagnosis of IMH. Similar to type A and B aortic dissection, surgery is 
indicated at patients with type-A IMH, as well as at patients with a persistent 
and/or recurrent pain. For any other patient (with type-B IMH without an 
incessant pain and/or without complications), medical treatment is suggested, as 
applied in the case of aortic dissection. The outcome of IMH in ascending aorta 
(type A) appears favourable after immediate (emergent or urgent) surgical 
intervention, but according to international bibliography patients with IMH of 
the descending aorta (type B) show similar mortality rates to those being 
subjected to conservative medical or surgical treatment. Endovascular surgery 
and stent-graft placement is currently indicated in type B IMH.