Diagnosis and Management of Acute Aortic Syndromes: Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma

2022 ◽  
Author(s):  
Rebecca Sorber ◽  
Caitlin W. Hicks
Keyword(s):  
Intramural Hematoma ◽  
Penetrating Aortic Ulcer ◽  
Diagnosis And Management ◽  
Acute Aortic Syndromes

Penetrating Aortic Ulcer and Intramural Hematoma

2015 ◽  
Author(s):  
Nanette R. Reed ◽  
Gustavo S. Oderich
Keyword(s):  
Endovascular Repair ◽  
Intramural Hematoma ◽  
Computed Tomographic Angiography ◽  
Classification Systems ◽  
Penetrating Aortic Ulcer ◽  
Computed Tomographic ◽  
Disease Spectrum ◽  
Acute Aortic Syndromes ◽  
Clinical Series ◽  
Aortic Media

Acute aortic syndrome is a spectrum of three overlapping clinical and anatomic diseases: penetrating aortic ulcers, intramural hematomas, and acute aortic dissections. All three entities are part of a disease spectrum, which is characterized by a disruption of the aortic media to a varying degree. Penetrating aortic ulcer, intramural hematoma, and aortic dissection can occur as isolated processes or can be found in association. Although the clinical presentations of the three conditions overlap to some extent, the diagnosis of each specific disease is largely based on specific imaging findings. All three entities are potentially life threatening, so prompt diagnosis and treatment are of paramount importance. Risk factors include hypertension, male sex, tobacco use, atherosclerosis, previous aortic operations, catheter-based interventions, bicuspid aortic valve, and connective tissue disorders. This review summarizes the clinical presentation, diagnosis, indications for repair, and endovascular strategies in patients with acute aortic syndromes. Tables outline early and late outcomes of contemporary clinical series of endovascular repairs of penetrating aortic ulcers and intramural hematomas. Figures show the overlapping features of acute aortic syndromes, progression of penetrating aortic ulcers, a large penetrating aortic ulcer in the proximal thoracic aorta (including representations before endovascular repair and after stent graft coverage), completion angiography demonstrating the patency of chimney and thoracic stent grafts, pre- and postoperative computed tomographic angiography after endovascular repair of a complicated penetrating aortic ulcer, and the Stanford and DeBakey classification systems.  This review contains 8 figures, 4 tables, and 73 references.

scholarly journals CONSERVATIVE TREATMENT AS A THERAPEUTIC OPTION FOR PENETRATING AORTIC ULCER OF THE AORTIC ARCH IN A PATIENT WITH BICUSPID AORTIC VALVE

2020 ◽  
Vol 73 (7) ◽  
pp. 1580-1582
Author(s):  
Olga Możeńska ◽  
Michał Wojewódzki ◽  
Diana Wiligórska ◽  
Natalia Wiligórska ◽  
Robert J. Gil ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Conservative Treatment ◽  
Aortic Arch ◽  
Bicuspid Aortic Valve ◽  
Therapeutic Option ◽  
Intramural Hematoma ◽  
Type A ◽  
Penetrating Aortic Ulcer ◽  
Asymptomatic Patients ◽  
Acute Aortic Syndromes

Penetrating aortic ulcer (PAU) is ulceration of an aortic atherosclerotic plaque penetrating through the internal lamina into the media. PAU is a rare condition and occurs in 2% – 7% of acute aortic syndromes (AAS); however, the actual incidence is unknown because of asymptomatic patients. One may treat it conservatively as well as surgically. We present a case of a 54-year-old man, who was admitted to hospital due to the exaggeration of exertional chest pain and persistent headaches. During coronary angiography, the suspicion of PAU was raised. Contrast-enhanced computed tomography confirmed the diagnosis. Transesophageal echocardiography showed bicuspid aortic valve with minimal calcification, the dilated ascending aorta, large atherosclerotic plaques in the aortic arch with ulceration (thickness: 5.0 – 5.5mm, diameter: 5 – 6 mm, depth: 3 – 4 mm), without intramural hematoma. Conservative treatment was chosen with uneventful 2-year follow-up. Although surgical management is advocated for patients with PAU type A, we demonstrated that type A PAU can be successfully treated conservatively as well.

scholarly journals Penetrating Atheromatous Ulcer as a Precursor of Aortic Dissection: A Case Report

2020 ◽  
Author(s):  
Priya Shah ◽  
Erik Polan
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Ulcer Patient ◽  
Intramural Hematoma ◽  
Ascending Aorta ◽  
Current Case ◽  
Penetrating Aortic Ulcer ◽  
Ct Angiogram ◽  
Acute Aortic Syndromes ◽  
Life Threatening

Abstract Background: Acute aortic syndromes include a range of life-threatening conditions with the most familiar entity being aortic dissection. However, variants of aortic dissection also include intimal tear without hematoma, aortic intramural hematoma, and lastly penetrating aortic ulcer (PAU), which will be the focus of this case report. Most PAUs are located in the descending thoracic aorta (85-95%), but they can also occur in the ascending aorta or arch as in the current case.Case Presentation: We report a case of a 77 year old male who presented with chief complaint of intermittent right-handed weakness associated with no numbness or mental status changes. Patient was admitted for stroke workup with unrevealing findings on CT (computed tomography) for acute abnormalities or any hemodynamically significant stenosis on carotid ultrasound. CT angiogram of head/neck revealed a penetrating aortic ulcer of the lateral aspect of the mid to distal ascending aorta. Patient was then transferred for further evaluation to a center of higher level care for further management.Conclusions: Patient was evaluated for surgical repair of penetrating ascending aortic ulcer. Patient underwent serial imaging throughout hospital course which showed grossly similar findings to prior examination and thus no surgical intervention was needed at that time. Patient was recommended to have follow up CT scan in one month to monitor progression of aortic ulcer. Penetrating aortic ulcers are rarely located in the ascending aorta and are considered precursors of life-threatening aortic dissections.

scholarly journals Penetrating Atheromatous Ulcer As A Precursor Of Aortic Dissection: A Case Report

2020 ◽  
Author(s):  
Priya Shah ◽  
Erik Polan
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Ulcer Patient ◽  
Intramural Hematoma ◽  
Ascending Aorta ◽  
Penetrating Aortic Ulcer ◽  
Ct Angiogram ◽  
Acute Aortic Syndromes ◽  
Life Threatening

Abstract Background: Acute aortic syndromes include a range of life-threatening conditions with the most familiar entity being aortic dissection. However, variants of aortic dissection also include intimal tear without hematoma, aortic intramural hematoma, and lastly penetrating aortic ulcer (PAU), which will be the focus of this case report. Most PAUs are located in the descending thoracic aorta (85-95%), but they can also occur in the ascending aorta or arch as in the current case. Case Presentation: We report a case of a 77 year old male who presented with chief complaint of intermittent right-handed weakness associated with no numbness or mental status changes. Patient was admitted for stroke workup with unrevealing findings on CT (computed tomography) for acute abnormalities or any hemodynamically significant stenosis on carotid ultrasound. CT angiogram of head/neck revealed a penetrating aortic ulcer of the lateral aspect of the mid to distal ascending aorta. Patient was then transferred for further evaluation to a center of higher level care for further management. Conclusions: Patient was evaluated for surgical repair of penetrating ascending aortic ulcer. Patient underwent serial imaging throughout hospital course which showed grossly similar findings to prior examination and thus no surgical intervention was needed at that time. Patient was recommended to have follow up CT scan in one month to monitor progression of aortic ulcer, however patient lost to follow-up thereafter. Penetrating aortic ulcers are rarely located in the ascending aorta and are considered precursors of life-threatening aortic dissections.

The Penetrating Aortic Ulcer: Pathologic Manifestations, Diagnosis, and Management

1988 ◽  
Vol 63 (7) ◽  
pp. 718-725 ◽  
Author(s):  
JOHN P. COOKE ◽  
FRANCIS J. KAZMIER ◽  
THOMAS A. ORSZULAK
Keyword(s):  
Penetrating Aortic Ulcer ◽  
Diagnosis And Management

Acute aortic syndromes

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Aortic Dissection ◽  
Intramural Haematoma ◽  
Penetrating Atherosclerotic Ulcer ◽  
Diagnosis And Management ◽  
Acute Aortic Syndromes

Acute aortic syndromes comprise aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Classification, presentation, diagnosis, and management of these conditions are discussed.

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