Aortic intramural hematoma (IMH) is a form of aortic disease characterized by bleeding into the aortic wall without the presence of an intimal tear or blood flow between the layers of the wall. IMH often occurs in hypertensive patients and can lead to serious complications such as aortic dissection or rupture[1][2]. The diagnosis is made using imaging methods such as CT, MRI, or transesophageal echocardiography, which show thickening of the aortic wall without an intimal tear[1][2]. IMH is classified according to the affected part of the aorta according to the Stanford classification into type A (ascending aorta) and type B (descending aorta). Patients with type B IMH have a better long-term prognosis than those with aortic dissection[1]. Treatment depends on severity and risk factors; in patients with high-risk type A features, urgent surgical intervention is recommended, while in elderly patients or with comorbidities, conservative treatment with regular follow-up may be appropriate[2]. Aorta size and hematoma thickness are important prognostic factors. For type A IMH, interventional treatment is recommended for aortic diameter ≥ 50 mm or hematoma thickness ≥ 11 mm, while for type B these values are ≥ 40 mm and ≥ 10 mm. Endovascular treatment (TEVAR) reduces complications and mortality compared to conservative treatment or open surgery, especially in patients who are not suitable for traditional surgery[3]. IMH may resolve spontaneously but may progress to classic aortic dissection in 8–78% of patients. Therefore, regular imaging is necessary during the first year after the onset of IMH and subsequently also in the long term