Penetrating atherosclerotic aortic ulcer: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Study of Choice=== | ===Diagnostic Study of Choice=== | ||
*Table below provides a comparison of diagnostic imaging studies for the diagnosis of penetrating atherosclerotic aortic ulcer:<ref name="pmid25173340">{{cite journal |vauthors=Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ |title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref> | |||
{| class="wikitable" | |||
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| align="center" style="background:#4479BA; color: #FFFFFF;" |Location | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |'''Diagnostic Modality''' | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnostic Value | |||
|- | |||
| rowspan="4" align="center" style="background:#f0f0f0;" |Penetrating atherosclerotic aortic ulcer | |||
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*[[Transthoracic echocardiography|Transthoracic Echocardiography]] | |||
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* Moderate | |||
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* Transesophageal echocardiography | |||
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* Moderate | |||
|- | |||
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* CT Scan | |||
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* Excellent | |||
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* MRI | |||
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* Excellent | |||
|} | |||
*Contrast-enhanced CT imaging is the diagnostic study of choice for diagnosis of penetrating atherosclerotic aortic ulcer. | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
===Physical Examination=== | ===Physical Examination=== | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
==Imaging | ==Imaging== | ||
* | ===Echocardigraphy=== | ||
* | *Tansesophageal echocardiography has been approved to be sensitive and specific for the diagnosis of aortic diseas.<ref name="pmid8668776">{{cite journal |vauthors=Sommer T, Fehske W, Holzknecht N, Smekal AV, Keller E, Lutterbey G, Kreft B, Kuhl C, Gieseke J, Abu-Ramadan D, Schild H |title=Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging |journal=Radiology |volume=199 |issue=2 |pages=347–52 |date=May 1996 |pmid=8668776 |doi=10.1148/radiology.199.2.8668776 |url=}}</ref> | ||
* | ===CT Scan=== | ||
*CT scan imaging with intravenous contrast is the diagnostic study of choice for diagnosis of penetrating atherosclerotic aortic ulcer.<ref name="HayashiMatsuoka2000">{{cite journal|last1=Hayashi|first1=Hideyuki|last2=Matsuoka|first2=Yohjiro|last3=Sakamoto|first3=Ichiro|last4=Sueyoshi|first4=Eijun|last5=Okimoto|first5=Tomoaki|last6=Hayashi|first6=Kuniaki|last7=Matsunaga|first7=Naofumi|title=Penetrating Atherosclerotic Ulcer of the Aorta: Imaging Features and Disease Concept|journal=RadioGraphics|volume=20|issue=4|year=2000|pages=995–1005|issn=0271-5333|doi=10.1148/radiographics.20.4.g00jl01995}}</ref> | |||
*Findings suggestive of penetrating atherosclerotic aortic ulcer include a localized ulcer passing from intima into aortic wall or contrast leak through a calcified plaque. | |||
*It usually affects mid to distal third of descending aorta. | |||
*Ulcer is usually defined by focal thickening or enhancement of aortic wall. | |||
===MRI=== | |||
*MRI study is superior to conventional CT scan in the diagnposis of penetrating atherosclerotic aortic ulcer.<ref name="HarrisBis1994">{{cite journal|last1=Harris|first1=James A.|last2=Bis|first2=Kostaki G.|last3=Glover|first3=John L.|last4=Bendick|first4=Phillip J.|last5=Shetty|first5=Anil|last6=Brown|first6=O.William|title=Penetrating atherosclerotic ulcers of the aorta|journal=Journal of Vascular Surgery|volume=19|issue=1|year=1994|pages=90–99|issn=07415214|doi=10.1016/S0741-5214(94)70124-5}}</ref> | |||
*Finding suggestive of the diagnosis includes a well-defined ulcer with flow void phenomenon on T1 images. | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
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==External Links== | ==External Links== | ||
*[http://goldminer.arrs.org/search.php?query=Penetrating%20atherosclerotic%20aortic%20ulcer Goldminer: Penetrating atherosclerotic aortic ulcer] | *[http://goldminer.arrs.org/search.php?query=Penetrating%20atherosclerotic%20aortic%20ulcer Goldminer: Penetrating atherosclerotic aortic ulcer] | ||
==References== | ==References== | ||
* [http://radiographics.rsnajnls.org/cgi/content/abstract/23/suppl_1/S93 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.] | * [http://radiographics.rsnajnls.org/cgi/content/abstract/23/suppl_1/S93 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.] | ||
{{Circulatory system pathology}} | {{Circulatory system pathology}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Revision as of 21:21, 31 December 2019
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.
Historical Perspective
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 [#]%.
Diagnosis
Diagnostic Study of Choice
- Table below provides a comparison of diagnostic imaging studies for the diagnosis of penetrating atherosclerotic aortic ulcer:[1]
| Location | Diagnostic Modality | Diagnostic Value |
| Penetrating atherosclerotic aortic ulcer |
| |
|
| |
|
| |
|
|
- Contrast-enhanced CT imaging is the diagnostic study of choice for diagnosis of penetrating atherosclerotic aortic ulcer.
History and Symptoms
Physical Examination
Laboratory Findings
Imaging
Echocardigraphy
- Tansesophageal echocardiography has been approved to be sensitive and specific for the diagnosis of aortic diseas.[2]
CT Scan
- CT scan imaging with intravenous contrast is the diagnostic study of choice for diagnosis of penetrating atherosclerotic aortic ulcer.[3]
- Findings suggestive of penetrating atherosclerotic aortic ulcer include a localized ulcer passing from intima into aortic wall or contrast leak through a calcified plaque.
- It usually affects mid to distal third of descending aorta.
- Ulcer is usually defined by focal thickening or enhancement of aortic wall.
MRI
- MRI study is superior to conventional CT scan in the diagnposis of penetrating atherosclerotic aortic ulcer.[4]
- Finding suggestive of the diagnosis includes a well-defined ulcer with flow void phenomenon on T1 images.
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.
Guideline
2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)[1]
| Recomendacations | Class | Level |
|---|---|---|
| "In all patients with PAU, medical therapy including pain relief and blood pressure control is recommended." | I | C |
| "In the case of Type A PAU, surgery should be considered." | IIa | C |
| "In the case of Type B PAU, initial medical therapy under careful surveillance is recommended." | I | C |
| "In uncomplicated Type B PAU, repetitive imaging (MRI or CT) is indicated." | I | C |
| "In complicated Type B PAU, TEVAR should be considered." | IIa | C |
| "In complicated Type B PAU, surgery may be considered." | IIb | C |
Examples
See Also
External Links
References
- ↑ 1.0 1.1 Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)". Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID 25173340.
- ↑ Sommer T, Fehske W, Holzknecht N, Smekal AV, Keller E, Lutterbey G, Kreft B, Kuhl C, Gieseke J, Abu-Ramadan D, Schild H (May 1996). "Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging". Radiology. 199 (2): 347–52. doi:10.1148/radiology.199.2.8668776. PMID 8668776.
- ↑ Hayashi, Hideyuki; Matsuoka, Yohjiro; Sakamoto, Ichiro; Sueyoshi, Eijun; Okimoto, Tomoaki; Hayashi, Kuniaki; Matsunaga, Naofumi (2000). "Penetrating Atherosclerotic Ulcer of the Aorta: Imaging Features and Disease Concept". RadioGraphics. 20 (4): 995–1005. doi:10.1148/radiographics.20.4.g00jl01995. ISSN 0271-5333.
- ↑ Harris, James A.; Bis, Kostaki G.; Glover, John L.; Bendick, Phillip J.; Shetty, Anil; Brown, O.William (1994). "Penetrating atherosclerotic ulcers of the aorta". Journal of Vascular Surgery. 19 (1): 90–99. doi:10.1016/S0741-5214(94)70124-5. ISSN 0741-5214.