CTICasesPenetrating Atherosclerotic Aortic Ulcer with Intramural Hematoma
Imaging findings
Contrast-enhanced CT of the chest demonstrates a large, focal, penetrating atherosclerotic ulcer in the descending thoracic aorta with a clear connection to the aortic lumen. There is extensive atheroma throughout the aorta. Elongating inferiorly from the ulcer is a high-attenuation crescent along the aortic wall, representing either a localized intramural hematoma or thrombosis within the media.
Key takeaways
Differentiating a simple localized penetrating atherosclerotic ulcer (PAU) from a focal dissection can be challenging when there is an associated elongated intramural hematoma. Although surgical or endovascular repair is often considered, elderly patients who become asymptomatic with medical blood pressure control may be managed conservatively.
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