Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations

Aortic Dissection: New Frontiers in Diagnosis and Management

“…[61][62][63][64][65] Noninvasive imaging of aortic ulceration has been improved by tomographic scanning and has shed light on pathophysiology and etiology. The ulcers seem to predominantly affect the descending thoracic aorta, as well as the abdominal aorta, in localized fashion; branch vessel compromise is rare.…”

“…2,60,62 Cerebrovascular manifestations and limb ischemia with pulse deficits are caused by involvement of a side branch orifice into the dissection or obliteration of the true lumen by an expanding false lumen. 61,66 Paraplegia may emerge if too many pairs of intercostal arteries are separated from the aortic lumen.…”

Acute aortic syndrome: a case presentation and review of the literature

“…AD is initiated by an intimal tear, presumably at the site of injury or instability, with resultant propagation within the middle third of the medial layer of the aorta. The etiology of IMH has been proposed to be due to rupture of the vasovasorum 6 ,7 or hemorrhage within an atherosclerotic plaque, 8 with development of a hematoma in the outer third of the medial layer. Others have suggested that IMH is simply AD with an unrecognized intimal ap, or that IMH is the precursor to AD.…”

Acute Aortic Syndrome: Recent Trends in Imaging Assessment Using Computed Tomography Angiography

“…In the traditional understanding of the development of IMH, hypertension can provoke aortic medial layer degeneration, resulting in spontaneous rupture of the vasa vasorum and leading to hema- Acute Aortic Syndrome CVIA toma formation with medial layer splitting [35,36]. On the other hand, in patients with severe atherosclerotic disease, rupture of a PAU or atherosclerotic plaque can result in intimal-medial injury and bleeding into the media [37]. Thus, the current opinion regarding IMH is that it can be a variant of or a precursor to aortic dissection with a small intimal defect and thrombosed false lumen without a re-entry tear [31,37].…”

“…On the other hand, in patients with severe atherosclerotic disease, rupture of a PAU or atherosclerotic plaque can result in intimal-medial injury and bleeding into the media [37]. Thus, the current opinion regarding IMH is that it can be a variant of or a precursor to aortic dissection with a small intimal defect and thrombosed false lumen without a re-entry tear [31,37]. The clinical presentation of IMH is similar to that of aortic dissection; thus, image-guided evaluation is essential for accurate diagnosis.…”