Penetrating Atherosclerotic Ulcers of the Abdominal Aorta: A Case Report and Review of the Literature

Abstract

Penetrating atherosclerotic ulcers (PAUs) of the aorta are defined as atherosclerotic lesions with aortic intima and media ulceration, which may lead to a complete rupture of the adventitial wall. The present article aimed to report an unusual case of a surgically treated patient with abdominal aorta PAU with an illustration of the key features and to review and analyze the existing literature data. PAUs typically develop in elderly and hypertensive patients and in patients with advanced atherosclerosis. Although originally described for the descending thoracic aorta, a similar clinicopathological entity also occurs in the abdominal aorta. Patients with symptoms of a PAU should be treated immediately if they are fit for surgery. Exceptive observation by imaging modalities is necessary in patients with asymptomatic small (<2 cm) PAU, with or without focal dissection.

Keywords: Abdominal aorta; Acute aortic syndrome; Penetrating atherosclerotic ulcer.

Fig. 1

The dimensions of the penetrating atherosclerotic ulcer mimicking a windsock as assessed by computed tomography imaging.

Fig. 2

(A–D) Contrast-enhanced computed tomography images of the abdominal and thoracic area revealed the presence of a saccular aneurysm (arrows) and a large intramural hematoma, findings compatible with a penetrating atherosclerotic ulcer.

Fig. 3

(A–C) Axial images as assessed by computed tomography imaging of the abdomen revealed the presence of a saccular aneurysm in the anatomical region of the abdominal aorta mimicking a windsock.

Fig. 4

(A, B) Intraoperative images of the penetrating atherosclerotic ulcer.

Fig. 5

Histopathological image revealed arterial wall with atherosclerotic lesions with diffuse ulceration of the intima and thrombus underneath the atherosclerotic intima and media layers (H&E, ×20).