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Penetrating Atherosclerotic Ulcer
Santiago Martínez-Jiménez, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Ulceration of atherosclerotic plaque that penetrates internal elastic lamina into media with variable amount of intramural hematoma (IMH)
                • Sometimes recognized as class 4 aortic dissection
              • Acute aortic syndrome (AAS) comprises aortic dissection (AD), incomplete aortic dissection (ID), penetrating aortic ulcer (PAU), and IMH

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          Selected References

                                          1. Bossone E et al: Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 39(9):739-49d, 2018
                                          2. El Hassani I et al: Penetrating atherosclerosis aortic ulcer: a re-appraisal. Acta Chir Belg. 117(1):1-7, 2017
                                          3. Gutschow SE et al: Emerging Concepts in Intramural Hematoma Imaging. Radiographics. 36(3):660-74, 2016
                                          4. Patatas K et al: Penetrating atherosclerotic ulcer of the aorta: a continuing debate. Clin Radiol. 68(8):753-9, 2013
                                          5. Akin I et al: Penetrating aortic ulcer, intramural hematoma, acute aortic syndrome: when to do what. J Cardiovasc Surg (Torino). 53(1 Suppl 1):83-90, 2012
                                          6. Bischoff MS et al: Penetrating aortic ulcer: defining risks and therapeutic strategies. Herz. 36(6):498-504, 2011
                                          7. Hiratzka LF et al: 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010 Apr 6;121(13):e266-369. Epub 2010 Mar 16. Erratum in: Circulation. 122(4):e410, 2010
                                          8. Vilacosta I et al: Acute aortic syndrome: a new look at an old conundrum. Postgrad Med J. 86(1011):52-61, 2010
                                          9. François CJ et al: MRI of the thoracic aorta. Cardiol Clin. 25(1):171-84, vii, 2007
                                          10. Hayashi H et al: Penetrating atherosclerotic ulcer of the aorta: imaging features and disease concept. Radiographics. 20(4):995-1005, 2000
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Ulceration of atherosclerotic plaque that penetrates internal elastic lamina into media with variable amount of intramural hematoma (IMH)
                                                        • Sometimes recognized as class 4 aortic dissection
                                                      • Acute aortic syndrome (AAS) comprises aortic dissection (AD), incomplete aortic dissection (ID), penetrating aortic ulcer (PAU), and IMH

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Angiographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  Selected References

                                                                                  1. Bossone E et al: Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 39(9):739-49d, 2018
                                                                                  2. El Hassani I et al: Penetrating atherosclerosis aortic ulcer: a re-appraisal. Acta Chir Belg. 117(1):1-7, 2017
                                                                                  3. Gutschow SE et al: Emerging Concepts in Intramural Hematoma Imaging. Radiographics. 36(3):660-74, 2016
                                                                                  4. Patatas K et al: Penetrating atherosclerotic ulcer of the aorta: a continuing debate. Clin Radiol. 68(8):753-9, 2013
                                                                                  5. Akin I et al: Penetrating aortic ulcer, intramural hematoma, acute aortic syndrome: when to do what. J Cardiovasc Surg (Torino). 53(1 Suppl 1):83-90, 2012
                                                                                  6. Bischoff MS et al: Penetrating aortic ulcer: defining risks and therapeutic strategies. Herz. 36(6):498-504, 2011
                                                                                  7. Hiratzka LF et al: 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010 Apr 6;121(13):e266-369. Epub 2010 Mar 16. Erratum in: Circulation. 122(4):e410, 2010
                                                                                  8. Vilacosta I et al: Acute aortic syndrome: a new look at an old conundrum. Postgrad Med J. 86(1011):52-61, 2010
                                                                                  9. François CJ et al: MRI of the thoracic aorta. Cardiol Clin. 25(1):171-84, vii, 2007
                                                                                  10. Hayashi H et al: Penetrating atherosclerotic ulcer of the aorta: imaging features and disease concept. Radiographics. 20(4):995-1005, 2000