Penetrating aortic ulcer (PAU)

Penetrating aortic ulcer (PAU) is one of the three important acute aortic syndromes, the other two being acute aortic dissection and intramural hematoma. Majority of the PAU occur in the descending thoracic aorta, which contributes to about sixty percent while nearly one third occur in the abdominal aorta [1]. Only around six percent are seen in the aortic arch. About half of the ulcers are isolated, without any associated intramural hematoma or saccular aneurysms. Nearly one fourth have associated saccular aneurysms while about a seventh of them have associated intramural hematoma. Important complications of penetrating aortic ulcer include aortic intramural hematoma, aortic dissection, pseudoaneurysm formation or even aortic rupture. Symptomatic ulcers are more likely to progress than an incidentally detected asymptomatic penetrating aortic ulcer. Computerized tomographic (CT) angiography is the investigation of choice for the diagnosis of PAU. The ulcer is seen as an projection of contrast material from the aortic lumen. Volume rendered three dimensional reconstruction of CT aortogram gives an excellent demonstration of the ulcers and any associated hematoma or aortic dissection. Progression is more likely in a symptomatic aortic ulcer, while an asymptomatic aortic ulcer with a diameter of more than two centimeters or a neck of more than a centimeter are considered more likely to progress [2]. Symptomatic aortic ulcers are better treated with endovascular aortic repair (...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs