Penetrating Aortic Ulcer and Intramural Hematoma

Oderich, Gustavo S.; Kärkkäinen, Jussi M.; Reed, Nanette R.; Tenorio, Emanuel R.; Sandri, Giuliano A.

doi:10.1007/s00270-018-2114-x

Cited by 78 publications

(83 citation statements)

References 84 publications

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“…IMH was defined as crescentic or circumferential thickening of the aortic wall (> 5 mm) without any intimal tear, comparing with aortic dissection (AD). PAU was considered as a focal disruption in the arterial intima and elastic lamina protruding into the media [4], whereas IMH associated with PAU was termed as PAU-IMH. Further differential diagnosis between PAU-IMH and rupture secondary to IMH was made with the presence or absence of intimal calcification [5] (Fig.…”

Section: Imaging Techniquesmentioning

confidence: 99%

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma

Liu

et al. 2020

J Cardiothorac Surg

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Background: Aortic intramural hematoma (IMH) is a subset of acute aortic syndrome, and its prognosis may differ between races. This study aimed to study the prognosis of Chinese type B IMH patients and to find out risk factors. Methods: A total of 71 type B IMH patients with or without penetrating atherosclerosis ulcer (PAU) administrated in our center between September 2013 and October 2017 were retrospectively studied. Both clinical and imaging data were collected and analyzed. The primary end point was aorta-related death, and the secondary end point was progression, which was defined as enlargement of aorta, increased aortic wall thickness, and aortic dissection or aneurysm formation. Kaplan-Meier survival analysis and Cox regression analysis were used for prognostic analysis. Results: Among these 71 patients, 21 had simple type B IMH, when 50 had type B IMH in association with PAU. Twenty-five patients received optimal medical therapy (OMT) alone, while 46 patients received surgery and OMT. The mean follow-up time was 27.5 ± 13.5 months. For type B IMH patients, association with PAU indicated poor prognosis and required more intensive management (HR = 16.68, 1.96~141.87), while maximum aortic diameter (MAD) was an independent risk factor (HR = 1.096, 1.016~1.182). For patients with PAU-IMH, MAD was an independent risk factor (HR = 1.04, 1.021~1.194), while surgical treatment was independent protective factor (HR = 0.172, 0.042~0.696). Conclusion: Association with PAU and MAD were independent risk factors for type B IMH patients. Surgery may improve the outcomes for type B IMH in association with PAU.

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Section: Imaging Techniquesmentioning

confidence: 99%

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma

Liu

et al. 2020

J Cardiothorac Surg

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“…When first described, PAU was considered a malignant entity with a high risk of rupture or progression to frank dissection. However, subsequent studies suggested a more benign course with watchful waiting advocated by several groups (51,52). This controversy is exemplified by the respectfully opposing views expressed by investigators at Yale University (53) and Mayo Clinic (54).…”

Section: Early Evolution Complications and Risk Stratificationmentioning

confidence: 99%

Intramural hematoma and penetrating ulcer in the descending aorta: differences and similarities

Evangelista¹,

Maldonado²,

Moral³

et al. 2019

Ann. Cardiothorac. Surg.

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Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. Intramural hematoma (IMH), penetrating atherosclerotic ulcer (PAU), and aortic dissection can occur as isolated processes or can be found in association. All these entities are potentially life threatening, so prompt diagnosis and treatment is of paramount importance. IMH and PAU affect patients with atherosclerotic risk factors and are located in the descending aorta in 60-70% of cases. IMH diagnosis can be correctly made in most cases. Aortic ulcer is a morphologic entity which comprises several entities-the differential diagnosis includes PAU, focal intimal disruptions (FID) in the context of IMH evolution and ulcerated atherosclerotic plaque. The pathophysiologic mechanism, evolution and prognosis differ somewhat between these entities. However, most PAU are diagnosed incidentally outside the acute phase. Persistent pain despite medical treatment, hemodynamic instability, maximum aortic diameter (MAD) >55 mm, significant periaortic hemorrhage and FID in acute phase of IMH are predictors of acute-phase mortality. In these cases, TEVAR or open surgery should be considered. In non-complicated IMH or PAU, without significant aortic enlargement, strict control of cardiovascular risk factors and frequent follow-up imaging appears to be a safe management strategy.

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“…Although their pathologies are different, their pathogenesis is not independent and overlap to a certain degree. [2][3][4][5][6] In this review, we discuss the differences in characteristics and clinical course of an aortic aneurysm from those of an aortic dissection and describe the use of recent CT strategies in diagnosing acute and chronic aortic diseases.…”

Section: Introductionmentioning

confidence: 99%

Updates on Computed Tomography Imaging in Aortic Aneurysms and Dissection

Tanaka

Yoshioka

Abiko

2020

Annals of Vascular Diseases

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Computed tomography (CT) is a primary imaging modality for the diagnosis of aortic diseases, because of its minimal invasiveness and agility. Prompt and accurate diagnosis is crucial especially for acute aortic diseases, and the guidelines for acute aortic dissection recommend the use of CT for initial diagnosis. For the follow-up observation of longstanding aortic diseases, the strategy of imaging management by CT must be different from that for emergency and acute phases. In this review, we document the differences in characteristics and clinical course between aortic aneurysm and aortic dissection and explain the use of recent CT techniques in diagnosing short-and longstanding aortic diseases.

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Penetrating Aortic Ulcer and Intramural Hematoma

Cited by 78 publications

References 84 publications

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma

Prognostic value of clinical and morphologic findings in patients with type B aortic intramural hematoma

Intramural hematoma and penetrating ulcer in the descending aorta: differences and similarities

Updates on Computed Tomography Imaging in Aortic Aneurysms and Dissection

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