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.
- 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 the 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).
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.
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
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].
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
History and Symptoms
Physical Examination
Laboratory Findings
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
Surgery
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.
Examples
See Also
External Links
References