Penetrating ulcer of the ascending aorta without rupture

Penetrating ulcer of the ascending aorta is a very rare pathological entity with known potential for progression towards intramural hematoma or dissection. Intraoperative diagnosis of an asymptomatic ulcer of the ascending aorta was carried in a 60-year-old male with rheumatic valve disease. The tubular portion of the aorta was slightly dilated (45 mm) and the aortic valve was tricuspid. A supracoronary replacement of the ascending aorta was performed with a Dacron tube. Pathological analysis of the operative sample showed a considerable thinning of the aortic wall with a complete lack of elastic fibers at the level of the penetrating ulcer surrounded by a slightly dystrophic ascending aorta free from calcification and atheroma.