Penetrating atherosclerotic aortic ulcer

Associate Editor-In-Chief:

Overview

 * Penetrating atherosclerotic aortic ulcer is an ulceration of atheromatous plaque that has eroded the inner, elastic layer of the aortic wall, reached the medial layer, and produced a hematoma in the media.


 * Involvement of the media can sometimes be complicated by aneurysmal dilatation or, more rarely, rupture.


 * Unlike typical aortic dissection, penetrating atherosclerotic ulcers most often occur in elderly patients with severe underlying atherosclerosis. *Ulcers typically involve the aortic arch and descending thoracic aorta (rarely in the ascending aorta where rapid flow from the left ventricle provides protection against atherosclerosis).


 * As for type B typical aortic dissection, the most widespread treatment for penetrating atherosclerotic ulcers is medical therapy.


 * Surgery is performed in patients who have hemodynamic instability, persistent pain, aortic rupture, distal embolization, or rapid enlargement of the aortic diameter (surgical repair of a penetrating atherosclerotic ulcer is generally more complex and extensive than surgical repair of type B typical aortic dissection).

Imaging Findings of

 * Extensive atherosclerosis and intramural hematoma are visible on unenhanced CT scans.
 * On contrast-enhanced CT scans, a collection of contrast material is seen outside the aortic lumen.


 * Atheromatous ulcers that are confined to the intimal layer sometimes have a radiologic appearance similar to that of penetrating atherosclerotic aortic ulcer; therefore, particular care should be taken in making a diagnosis of penetrating atherosclerotic ulcer if the lesions are discovered incidentally in an asymptomatic patient and if associated focal intramural hematoma is absent.