Aortic intramural hematoma (IMH) is an acute aortic syndrome characterized by 
bleeding into the media of the aortic wall without intimal disruption or the 
classic flap formation. Its natural history is variable and still poorly 
understood, so strategies for therapeutic management are not fully established. 
In some cases there is partial or complete regression of the hematoma under 
medical treatment, but most progress to dissection, aneurysmal dilatation or 
aortic rupture. The authors present the case of a 44-year-old hypertensive male 
patient admitted with a diagnosis of IMH of the descending aorta. Despite 
initial symptom resolution and optimal medical therapy, the IMH evolved to a 
pseudoaneurysm, which was successfully treated by an endovascular approach.