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penetrating aortic atherosclerotic ulcer
Etiology:
- complication of atherosclerosis
Epidemiology:
- elderly with cardiovascular comorbidity
Pathology:
- focal defect in aortic wall at the site of an intimal aortic atheroma
- most common in the descending aorta
Laboratory:
- plasma D-dimer frequently elevated
- serum troponin is normal
- pulse oximetry vs arterial blood gas to exclude hypoxia consistent with pulmonary embolism
Radiology:
- contrast-enhanced CT of aorta
Complications:
- acute aortic syndrome
Differential diagnosis:
- myocardial infarction
- pulmonary embolism
Management:
- esmololol drip followed by nitroprusside
- emergency surgery with endovascular repair*
- indications
- > 20 mm in diameter & > 10 mm in depth
- associated intramural hematoma
- evidence of visceral ischemia or lower limb ischemia
* open repair rarely indicated
General
ulcer
aortic atheroma
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17
American College of Physicians, Philadelphia 2012, 2015
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Sorber R, Hicks CW.
Diagnosis and management of acute aortic syndromes: dissection,
penetrating aortic ulcer, and intramural hematoma.
Curr Cardiol Rep. 2022;24:209-216.
PMID: 35029783