CTICasesPenetrating Atherosclerotic Ulcer
Imaging findings
Lateral chest radiograph shows abnormal soft-tissue opacity in the subaortic region (hilar bagel/doughnut sign completed under the left main bronchus). Axial and sagittal CT images demonstrate a massive pseudoaneurysm of the descending thoracic aorta with a large mediastinal hematoma, arising from a disrupted atherosclerotic plaque (penetrating atherosclerotic ulcer). The lesion was successfully treated with an endovascular stent graft.
Key takeaways
A penetrating atherosclerotic ulcer (PAU) is a component of acute aortic syndrome, where plaque ulceration erodes through the internal elastic lamina into the media. This can progress to pseudoaneurysm formation, media dissection, or aortic rupture. On radiography, the surrounding mediastinal hemorrhage can manifest as abnormal hilar opacity (doughnut sign), requiring urgent CTA and endovascular stenting (TEVAR).
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Impella Device FailureIatrogenic
- Hard Metal PneumoconiosisILD
- Vaping-Induced Hard Metal PneumoconiosisILD
- Hypoattenuating Leaflet ThickeningIatrogenic
- IVC Filter Strut Fracture and MigrationIatrogenic
- LVAD Outflow Graft CompressionIatrogenic
- Subcutaneous Identification MicrochipArtifact
- Fat Embolism SyndromeIatrogenic
See all cases from October 6, 2017 →
Related Vascular cases
- Pulmonary Arterial Hypertension with Systemic-to-Pulmonary Collateral Vessels
- Acute Type A Aortic Dissection with Displaced Intimal Calcification
- Chronic Aortic Dissection / Aneurysm with Arch Vessel Involvement
- Acute Type A Dissection with Hemopericardium and Right AV Groove Hematoma
- Pulmonary Embolism with Pulmonary Hemorrhage
- Ascending Aortic Graft Pseudoaneurysm with Pulmonary Artery Fistula