Penetrating atherosclerotic aortic ulcer

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List of terms related to Penetrating atherosclerotic aortic ulcer

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 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.

Classification

There is no established system for the classification of penetrating atherosclerotic aortic ulcer.

Pathophysiology

The exact pathogenesis of penetrating atherosclerotic aortic ulcer is not fully understood.

Causes

Penetrating atherosclerotic aortic ulcer may be caused by [cause1], [cause2], or [cause3].

Differentiating Penetrating atherosclerotic aortic ulcer from Other Diseases

Penetrating atherosclerotic aortic ulcer must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

Unlike typical aortic dissection, penetrating atherosclerotic ulcers most often occur in elderly patients with severe underlying atherosclerosis.

Risk Factors

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Screening

There is insufficient evidence to recommend routine screening for penetrating atherosclerotic aortic ulcer.

Natural History, Complications, and Prognosis

Ulcers typically involve the aortic arch and descending thoracic aorta (rarely in the ascending aorta where the rapid flow from the left ventricle provides protection against atherosclerosis).

If left untreated, [#]% of patients with penetrating atherosclerotic aortic ulcer may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Common complications of penetrating atherosclerotic aortic ulcer include [complication 1], [complication 2], and [complication 3].

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

Prognosis is generally poor, and the 1/5/10-year mortality/survival rate of patients with penetrating atherosclerotic aortic ulcer is approximately [#]%.

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 the associated focal intramural hematoma is absent.

Treatment

Medical Therapy

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

Surgery

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).

Primary Prevention

There are no established measures for the primary prevention of penetrating atherosclerotic aortic ulcer.

Secondary Prevention

There are no established measures for the secondary prevention of penetrating atherosclerotic aortic ulcer.

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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