Management of penetrating aortic ulcer and intramural hematoma in the thoracic aorta

Abstract

Acute aortic syndrome is a broad clinical entity that encompasses several pathologies. Aortic dissection is a well-studied disorder, but the other most prominent disorders within the scope of acute aortic syndrome, penetrating aortic ulcer and intramural hematoma, are more nebulous in terms of their pathophysiology and treatment strategies. While patient risk factors, presenting symptoms, and medical and surgical management strategies are similar to those of aortic dissection, there are indeed nuanced differences unique to penetrating aortic ulcer and intramural hematoma that surgeons and acute care providers must consider while managing patients with these diagnoses. The aim of this review is to summarize patient demographics, pathophysiology, workup, and treatment strategies that are unique to penetrating aortic ulcer and intramural hematoma.

Keywords: Acute aortic syndrome; Intramural hematoma; Penetrating aortic ulcer.

Fig. 1

Sagittal section of a CT angiogram of the chest demonstrating penetrating aortic ulcer in segment 3 of the aorta, denoted by asterisk

Fig. 2

Axial section of a CT angiogram of the chest demonstrating intramural hematoma, indicated by stars, at the level of T7 (a). Sagittal section of the same study (b)

Fig. 3

Sagittal section of a CT angiogram of the chest demonstrating penetrating aortic ulcer (asterisk) at the level of T8 with associated intramural hematoma (star)