Penetrating Aortic Ulcer

Definition, Etiology, PathogenesisTop

Penetrating aortic ulcer (PAU) refers to ulceration of an aortic atherosclerotic plaque that penetrates through the internal elastic lamina into the media. In the acute phase, penetrating aortic ulcers may present and are managed in a similar fashion to acute aortic dissections and intramural hematomas.

Clinical Features and Natural HistoryTop

PAU may result in intramural hematoma, pseudoaneurysm, aortic dissection, or aortic rupture. Clinical features usually found in patients with PAU include advanced age, male sex, tobacco smoking, hypertension, coronary artery disease, chronic obstructive pulmonary disease, and abdominal aneurysm. Clinical manifestations may be similar to those in aortic dissection but signs of organ hypoperfusion are rarely seen. PAUs are associated with progressive enlargement of the aorta and development of aneurysms.

DiagnosisTop

Contrast-enhanced computed tomography angiography (CTA) is the study of choice.

TreatmentTop

1. Medical treatment: Control of pain and blood pressure.

2. Invasive treatment: Consider surgery in patients with a PAU in the ascending aorta. Indications for invasive treatment in the descending thoracic aorta (preferably endovascular) include recurrent or refractory pain as well as signs of contained rupture (a rapidly growing aortic ulcer with periaortic hematoma or pleural effusion).