Penetrating atherosclerotic aortic ulcer

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

• Penetrating atherosclerotic aortic ulcer is an ulceration of atheromatous plaque that has eroded the inner, elastic layer of the aortic wall, reached the medial layer, and produced a hematoma in the media.

• Involvement of the media can sometimes be complicated by aneurysmal dilatation or, more rarely, rupture.

• Unlike typical aortic dissection, penetrating atherosclerotic ulcers most often occur in elderly patients with severe underlying atherosclerosis. *Ulcers typically involve the aortic arch and descending thoracic aorta (rarely in the ascending aorta where rapid flow from the left ventricle provides protection against atherosclerosis).

• As for type B typical aortic dissection, the most widespread treatment for penetrating atherosclerotic ulcers is medical therapy.

• Surgery is performed in patients who have hemodynamic instability, persistent pain, aortic rupture, distal embolization, or rapid enlargement of the aortic diameter (surgical repair of a penetrating atherosclerotic ulcer is generally more complex and extensive than surgical repair of type B typical aortic dissection).

Imaging Findings of Penetrating atherosclerotic aortic ulcer

• Extensive atherosclerosis and intramural hematoma are visible on unenhanced CT scans.
• On contrast-enhanced CT scans, a collection of contrast material is seen outside the aortic lumen.

• Atheromatous ulcers that are confined to the intimal layer sometimes have a radiologic appearance similar to that of penetrating atherosclerotic aortic ulcer; therefore, particular care should be taken in making a diagnosis of penetrating atherosclerotic ulcer if the lesions are discovered incidentally in an asymptomatic patient and if associated focal intramural hematoma is absent.

See Also

• Aortic dissection
• Aortic intramural hematoma

External Links

• Goldminer: Penetrating atherosclerotic aortic ulcer

References

• Eva Castañer, Marta Andreu, Xavier Gallardo, Josep Maria Mata, María Ángeles Cabezuelo, and Yolanda Pallardó. CT in Nontraumatic Acute Thoracic Aortic Disease: Typical and Atypical Features and Complications. RadioGraphics 2003 23: S93-110S.

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