Penetrating atherosclerotic ulcers of the aorta

Abstract

This study investigates the natural history and optimal imaging modality of penetrating atherosclerotic ulcers of the aorta. Methods: We reviewed our experience with 29 penetrating ulcers in 18 patients. Computed tomography (17 patients), magnetic resonance imaging (nine patients), and aortography (five patients) were used for diagnosis and follow-up. Patients were typically elderly (average age 74 years) and had hypertension and coronary artery disease. Ulcers were most common in the distal descending thoracic aorta (31 %) and were characterized by a discrete ulcer crater (100%) and thickened aortic wall (89%). Modes of presentation included chest or back pain in four patients, distal embolization in two patients, and abnormal chest radiography results in one; the remaining were incidental findings. Results: Follow-up was available in ten patients with 17 ulcers from 1 to 7 years. Recurrent pain occurred in two patients, recurrent embolization occurred in one patient, and seven patients remained symptom free. Progression to saccular pseudo aneurysm occurred in five ulcers, and fusiform aneurysm occurred in two ulcers. Two ulcers were associated with an increase in aortic diameter, and nine ulcers did not change. There were no cases of aortic dissection or rupture in the follow-up period. There were no deaths and only one patient underwent resection. Conclusion:The natural history of penetrating atherosclerotic ulcers is one of progressive aortic enlargement, with saccular and fusiform aneurysms the result if follow-up is sufficient. Aortic dissection, aortic rupture, and embolization can also occur but are less common. Contrast-enhanced computed tomography is the primary imaging modality.

Prognosis of Aortic Intramural Hematoma With and Without Penetrating Atherosclerotic Ulcer

“…Stanson et al 2 and Coady et al 7 found PAUs to be malignant, but most of these patients had acute symptoms. In contrast, Harris et al 16 and Quint et al 17 reported a lower incidence of life-threatening complications in a patient sample where asymptomatic patients were enrolled. The considerable difference in prognosis probably can be explained by the differences in patient substrate (symptomatic versus asymptomatic).…”

Rare Complication of Saccular Aneurysm and Histological Dissection. An Autopsy Study of 5865 Elderly Cases.

“…The prototype of this lesion may be an ulcer-like lesion. [8][9][10][11] Cystic medial necrosis was observed in the non-dissecting segment of the aorta of Case 1 and this degeneration might be the underlying abnormality of these lesions, although its significance in dissection is controversial. [12][13][14][15][16][17][18] Marsalese, et al 19) reported that 53% of patients with cystic medial necrosis died of aortic dissection or rupture.…”

A Case of Penetrating Aortic Atherosclerotic Ulcer with Hemoptysis.

“…Penetrating aortic ulcers rarely lead to transmural rupture of the aorta, [5][6] and no papers showing a penetrating aortic ulcer complicated with an extra-aortic hematoma were found. However, Coady, et al 7) found that intramural hematomas had higher rupture rates than classic aortic dissections, probably because the level of blood collection is more superficial and closer to the adventitia than that of aortic dissection.…”