penetrating aortic atherosclerotic ulcer

Etiology

• complication of atherosclerosis

Epidemiology

• elderly with cardiovascular comorbidity

Pathology

• focal defect in aortic wall at the site of an intimal aortic atheroma
• most common in the descending aorta

Laboratory

• plasma D-dimer frequently elevated
• serum troponin is normal
• pulse oximetry vs arterial blood gas to exclude hypoxia consistent with pulmonary embolism

Radiology

• contrast-enhanced CT of aorta

Complications

• acute aortic syndrome

Differential diagnosis

• myocardial infarction
• pulmonary embolism

Management

• esmololol drip followed by nitroprusside
• emergency surgery with endovascular repair*
  • indications
    • > 20 mm in diameter & > 10 mm in depth
    • associated intramural hematoma
    • evidence of visceral ischemia or lower limb ischemia

* open repair rarely indicated

More general terms

• ulcer
• aortic atheroma