HWN Suggests

Penetrating Atherosclerotic Aortic Ulcer

Up to 20% of patients will be asymptomatic on presentation; however, most patients complain of anterior chest or midscapular back pain. PAU is uniformly associated with hypertension and presents between the seventh and ninth decades of life.

Management of ascending PAU is emergent surgical repair while descending PAU can be managed with tight blood pressure control and repeat imaging. PAU is a rare but serious clinical entity. While the rate of rupture is as high as 40% in one series of symptomatic patients, many reports suggest a much lower rate when PAU is an incidental diagnosis.

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Articles of Interest

Penetrating atherosclerotic ulcer

The differential diagnosis of PAU with other aortic ulcers based on clinical and imaging technique information is mandatory as it may imply different prognosis and management. This diagnosis is particularly important when PAU is the cause of acute aortic syndromes as urgent invasive treatment should be recommended.

Prognostication of Asymptomatic Penetrating Aortic Ulcers: A Modern Approach

Penetrating aortic ulcers (PAUs), along with aortic dissection and intramural hematoma, are the pathogeneses of acute aortic syndrome. Although it was described as early as the 1930s, PAU was not recognized as a unique clinical entity until 1986, defined as a pathological ulceration through the intima and elastic lamina, into the media of the vessel.

The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

Penetrating aortic ulcers (PAUs) are an entity within acute aortic syndrome. They often remain undiagnosed and are found incidentally or when they become symptomatic. Management is currently guided by clinical judgment.

The Management of Penetrating Aortic Ulcer

PAU should be treated as a distinct clinical entity as it differs from AD and aneurysm scenarios in important ways. PAU often occurs in elderly, unfit patients with severe hypertension and with profound atherosclerotic disease

Acute Aortic Syndrome: Aortic Dissection, Intramural Hematoma and Penetrating Ulcer

Rarely rupture, yet worse prognosis due to extensive atherosclerosis which causes organ failure (e.g. acute myocardial infarction). Cause of most saccular aneurysms.

Aortic Intramural Hematomas and Penetrating Aortic Ulcerations: Indications for Treatment Versus Surveillance

First diagnosed as a unique condition in 1986 by Stanson et al, an isolated PAU is characterized by disruption of the arterial intima and elastic lamina that extends into the media within the atherosclerotic aorta.7 This disruption results in a focal outpouching through an area of vascular calcification with associated arterial flow and is most often noted on CTA

Resources

Radiopaedia

Penetrating atherosclerotic ulcers (PAU) are pathologies that involve the aortic wall and along with aortic dissection and aortic intramural hematoma, form the spectrum of acute aortic syndrome.