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Case Reports
. 2022 Jul 31;14(7):e27536.
doi: 10.7759/cureus.27536. eCollection 2022 Jul.

Penetrating Aortic Ulceration With Pseudoaneurysm and Intramural Hematoma: Emergency Department Management and Point-of-Care Ultrasound Diagnosis

Derrick Huang  1 , Alexander Huttleston  2   1 , Frank Fraunfelter  1 , Leoh N Leon  3   1 , Latha Ganti  1   4   5
Affiliations
Case Reports

Penetrating Aortic Ulceration With Pseudoaneurysm and Intramural Hematoma: Emergency Department Management and Point-of-Care Ultrasound Diagnosis

Derrick Huang et al. Cureus. .

Abstract

Penetrating aortic ulcer (PAU) complicated by an intramural hematoma is a rare and potentially life-threatening emergency department (ED) presentation that is defined by progressive ulceration through the intima layer into the media layer of the aorta. Symptomatic PAUs can be clinically indistinguishable from other life-threatening pathologies such as aortic dissection, acute coronary syndrome (ACS), intrabdominal catastrophes as well as less lethal processes such as musculoskeletal back pain. Given the potential of PAUs to result in lethal aortic rupture and dissection, the emergency provider should maintain a high index of suspicion in patients with risk factors for aortic pathologies and utilize diagnostic modalities such as point-of-care ultrasound (POCUS) to expedite diagnosis.

Keywords: aortic dissection; aortic injury; aortic ulceration; emergency medicine; peripheral arterial disease.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Sonogram depicting an asymmetric outpouching of the aortic wall without an intimal flap
Figure 2
Figure 2. Computed tomography angiography (CTA) axial view, demonstrating aortic ulceration with pseudoaneurysm and intramural hematoma extending through the aortic wall
Figure 3
Figure 3. Coronal view CTA demonstrating aortic ulceration with pseudoaneurysm and intramural hematoma extending through the aortic wall
See this image and copyright information in PMC

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