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 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.
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