Penetrating aortic ulcer manifesting as atypical chest pain

Abstract

A 57-year-old woman presented to the emergency department with focal, sharp pain radiating to her back for one month. Past medical history was significant for hypertension, hyperlipidemia, tobacco use, and extensive peripheral arterial disease. A lateral chest X-ray revealed a posterior convexity projecting off the proximal descending aorta (Figure 1). Given her renal insufficiency, a magnetic resonance angiogram (MRA) was performed using ferumoxytol. It demonstrated a large 2.0  2.5 cm penetrating aortic ulcer on the lateral proximal descending thoracic aorta (Figure 2). Following hydration protocol, this was later demonstrated on a computed tomography angiogram (CTA) in anticipation of percutaneous repair (Figure 3a-c). The patient underwent repair with placement of an endoluminal aortic stent graft with immediate resolution of chest pain (Figure 4). She remained chest pain free at her one month follow-up appointment.