Elsevier

Cardiology Clinics

Volume 17, Issue 4, 1 November 1999, Pages 637-657
Cardiology Clinics

PATHOLOGIC VARIANTS OF THORACIC AORTIC DISSECTIONS: Penetrating Atherosclerotic Ulcers and Intramural Hematomas

https://doi.org/10.1016/S0733-8651(05)70106-5Get rights and content
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Penetrating atherosclerotic ulcer (PAU) and intramural hematoma (IMH) of the aorta were virtually unknown in the prior era of aortic imaging by aortography. These disorders were not defined as radiographically distinct until the mid-1980s.28, 33 In the current era of three-dimensional, high resolution imaging of the aorta by computerized tomography (CT), magnetic resonance (MR) imaging, and transesophageal echocardiography (TEE), these two disorders have become increasingly recognized. The distinctions from typical aortic dissection have not always been clear in terms of diagnosis, clinical characteristics, and treatment.

Most reports of PAU and IMH in the literature have concentrated on identifying these disorders as entities distinct from classic aortic dissection by describing small series of these patients.* There is growing concern that the anatomic pathology and clinical behavior of PAU and IMH may differ substantially from those of typical aortic dissection, and that clinical management may need to be specifically tailored. In particular, it is becoming more apparent that the paucity of information and relative rarity of diagnosis are due to the fact that cases of PAU and IMH are often misdiagnosed and managed as “aortic dissections.”

The infrequence, misdiagnosis by initial radiologic inspection, and lack of clinical experience with PAU and IMH has not permitted definition of optimal therapy for these two variants of aortic disease. The present review draws on our experience at the Yale Center for Thoracic Aortic Disease in order to clarify the disorders of PAU and IMH of the aorta. This article expands on our initial report2 and reviews the clinical features, radiographic appearance, pathologic findings, and natural history of individuals with PAU and IMH. Appropriate correlates regarding the optimal treatment of these individuals are also discussed.

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Address reprint requests to John A. Elefteriades, MD, Section of Cardiothoracic Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510

*

References 1, 4, 11, 14, 15, 19, 23, 28