Potential interest of intra-aorta ultrasound imaging for the diagnosis of aortic penetrating atherosclerotic ulcer

Abstract

A 72-year-old man was admitted to our hospital for acute back pain. Transesophageal echocardiography (TEE), computed tomography (CT) and magnetic resonance imaging (MRI) all showed the presence of intramural hematoma (IMH) located in the descending aorta, with bilateral pleural effusions. The patient was initially referred for medical therapy and 'watchful waiting'. However, he continued to have back pain, so we decided to perform invasive aortography examination and intra-aortic ultrasound (IAU) imaging. No penetrating aortic ulcer (PAU) was found on multiple angiographic views, but intra-aorta ultrasound imaging clearly showed a PAU measuring 3x1 mm(2) in connection with the intramural hematoma. Even retrospective analysis of CT images failed to reveal this PAU. Therefore, we think that IAU imaging may be a useful tool in the diagnosis of PAU.

Intravascular ultrasound imaging in evaluation of aortic stiffness: A proof-of-concept study

“…Weintraub et al [ 26 ] in 1990 is the first to use IVUS for the assessment of a patient with aortic dissection. Since then, there are several reports and studies described in the literature about the application of IVUS for imaging of the diseased aorta [ 27 – 29 ]. In 1985 Hughes et al [ 30 ] described an in vivo experiment to evaluate aortic distention in dogs by intravascular ultrasonic catheter with simultaneous measurement of intra-aortic pressure.…”

s A fatal outcome of thoracic aortic aneurysm in a male patient with bicuspid aortic valve

“…It is particularly useful in assessing the presence of IMH or PAU if other methods give inadequate results, but as an invasive procedure and due to its limited availability, it is not a first step modality in AD diagnosis [37, 38]. …”

“…Intravascular ultrasound, with its sensitivity and specificity close to 100% in evaluating AD, overcomes known limitations of conventional aortography as the aortic wall is visualized from inside the lumen. It is particularly useful in assessing the presence of IMH or PAU if other methods give inadequate results, but as an invasive procedure and due to its limited availability, it is not a first step modality in AD diagnosis [ 37 , 38 ].…”

Penetrating Atherosclerotic Ulcerative Disease of the Aorta: Do Emergency Physicians Need to Worry?

“…It was concluded that progression of the PAU was slow, with a low prevalence of acute rupture or other life-threatening complications (21). Other authors reported a more negative prognosis with respect to classic aortic dissection, with a high incidence of complications (3,4,10,11,(15)(16)(17)22).…”

“…TEE has been less well studied than CT and MRI for the diagnosis of PAU of the aorta, so its utility as a diagnostic tool for this condition is unknown (17). Only some published case reports suggest that TEE can successfully identify this pathology (22). TEE offers some advantages that include portability and the ability to obtain high-resolution images of the aortic wall (17).…”