[Penetrating aortic ulcer: clinical and angiographic characteristics]

"Penetrating aortic ulcer", an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows haematoma formation within the aortic wall, is rarely considered in the differential diagnosis of patients with sudden onset of severe chest or back pain. It has been suggested that it is a pathologic process that involves elderly hypertensive patients with severe atherosclerosis and rarely has been observed in the ascending aorta.

To determine the characteristics of this process, 11 clinical, 2 hemodynamic, 3 angiographic and 4 surgical variables were compared between 10 consecutive patients with penetrating aortic ulcers and 20 matched patients with classic acute aortic dissection.

Clinical and hemodynamic variables were similar in both compared groups. In the group of patients with penetrating ulcer mean age was 58 +/- 6 years, previous hypertension was observed in 6 patients and the penetrating ulcer was located in the ascending aorta in 6 cases. In comparison to patients with aortic dissection, more angiographic projections were necessary to obtain the diagnosis in the group of patients with penetrating ulcer (2.4 +/- 0.8 vs 1.7 +/- 0.6; p < 0.05). In addition, the presence of angiographic aortic valve regurgitation was only observed in the group of patients with acute dissection (60% vs 0%; p < 0.001). Severe atherosclerosis was not present angiographically in any patient with penetrating ulcer.

Penetrating aortic ulcer can also affect middle age patients without severe atherosclerosis and is frequently observed in the ascending aorta. Its form of presentation and clinical characteristics are similar to classic aortic dissection. The lack of angiographic confirmatory evidence of dissection with suggestive clinical history, should raise the possibility of penetrating aortic ulcer.