Penetrating ulcer of the thoracic aorta: What is it

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Presentation transcript:

Penetrating ulcer of the thoracic aorta: What is it Penetrating ulcer of the thoracic aorta: What is it? How do we recognize it? How do we manage it? Michael A. Coady, MD, John A. Rizzo, PhD, Graeme L. Hammond, MD, John G. Pierce, MD, Gary S. Kopf, MD, John A. Elefteriades, MD Journal of Vascular Surgery Volume 27, Issue 6, Pages 1006-1016 (June 1998) DOI: 10.1016/S0741-5214(98)70003-5 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Computed tomographic scan of patient 3 (Table II) at middle level of the descending thoracic aorta. Clearly demonstrated is a contrast medium–filled penetrating ulcer. No intimal flap is seen. B, Computed tomographic scan shows classic type B aortic dissection for comparison. Intimal flap and both true and false lumens are present. Journal of Vascular Surgery 1998 27, 1006-1016DOI: (10.1016/S0741-5214(98)70003-5) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Aortic angiogram confirms diffuse atherosclerotic disease in patient 3 (Table II). This patient had a penetrating ulcer confirmed by means of CT scan. Journal of Vascular Surgery 1998 27, 1006-1016DOI: (10.1016/S0741-5214(98)70003-5) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Magnetic resonance image of the thorax demonstrates a pseudoaneurysm caused by a penetrating ulcer in the descending aorta. Journal of Vascular Surgery 1998 27, 1006-1016DOI: (10.1016/S0741-5214(98)70003-5) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Kaplan-Meier 1-year survival rates for patients with penetrating ulcer and type A and type B aortic dissection. Journal of Vascular Surgery 1998 27, 1006-1016DOI: (10.1016/S0741-5214(98)70003-5) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Gross specimen. Serial sections through the aorta reveal a transmural penetrating ulcer in a patient who died of aortic rupture (patient 4, Table II). Journal of Vascular Surgery 1998 27, 1006-1016DOI: (10.1016/S0741-5214(98)70003-5) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Computed tomographic scan of a patient with an intramural hematoma. Journal of Vascular Surgery 1998 27, 1006-1016DOI: (10.1016/S0741-5214(98)70003-5) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions