Abstract
“Penetrating aortic ulcer,” an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows hematoma formation within the aortic wall, is rarely considered in the differential diagnosis of patients with sudden onset of severe chest or back pain. It has been suggested that it is a pathologic process that involves elderly hypertensive patients with severe atherosclerosis and rarely has been observed in the ascending aorta. To determine the characteristics of this process, 11 clinical, 2 hemodynamic, 3 angiographic, and 4 surgical variables were compared between 10 consecutive patients with penetrating aortic ulcers and 20 matched patients with classic acute aortic dissection. Clinical and hemodynamic variables were similar in the two compared groups. In the group of patients with penetrating ulcer, mean age was 58 ± 6 years, previous hypertension was observed in six patients and the penetrating ulcer was located in the ascending aorta in six cases. Compared with patients with aortic dissection, more angiographic projections were necessary to obtain the diagnosis in the group of patients with penetrating ulcer (2.4 ± 0.8 vs 1.7 ± 0.6; p < 0.05). In addition, the presence of angiographic aortic valve regurgitation was only observed in the group of patients with acute dissection (60% vs 0%; p < 0.01). Severe atherosclerosis was not present angiographically in any patient with penetrating ulcer. In conclusion, penetrating aortic ulcer can also affect middle-age patients without severe atherosclerosis and is frequently observed in the ascending aorta. Its form of presentation and clinical characteristics are similar to classic aortic dissection. The lack of confirmatory evidence of dissection with suggestive clinical history should raise the possibility of penetrating aortic ulcer.
