Aortic ulcer

Clinical Applications 300 Aortic Aneurysm 300 Thoracic Aortic Aneurysm 300 Abdominal Aortic Aneurysm 302 Inflammatory Aortic Aneurysm 303 Aortic Dissection 304 Stanford A Dissection 305 Stanford B Dissection 305 Penetrating Aortic Ulcer 306 IMH 306 Aortitis 307 Injury of the Aorta 307 CTA in Endovascular Aortic Reconstruction 308... 

The penetrating aortic ulcer (PAU) is defined as a type IV lesion of the aortic wall (Task Force of the European Society of Cardiology 2001). By definition, it is an ulcerating atherosclerotic lesion, which breaks through the inner elastic membrane of the media and may lead to an intramural hematoma (IMH). In many cases, there are multiple ulcers of diameters up to 25 mm and an expansion up to 30 mm deep into the aortic wall (SuNDT 2002). They are often accompanied by atherosclerotic aneurysms of the abdominal aorta. The PAU can be seen in CTA as a contrast-enhanced bulge of the aortic wall (spurious aneurysm). Additionally,... 

Fig. 24.2. a Patient with thoracoabdominal penetrating aortic ulcer, b Transverse section at TIO, with evidence of anterior spinal artery, ASA (J) being accompanied by a second artery (Adamkiewicz artery [AKA]) (2). C Oblique coronal reforma-... 

A2A receptors that are present on sensory nerves in the carotid body, aortic body and elsewhere in the periphery produce excitatory sensory input. These receptors have been implicated in the production of pain associated with angina pectoris, ulcer and the human blister base preparation. 

Five days before he presented with esophageal ulceration, a 35-year-old man took two capsules of mefenamic acid (total dose 500 mg) in bed with a small amount of water. The following morning he noted severe retrosternal pain, which persisted until he was seen 4 days later. Endoscopy showed a 3 cm esophageal ulcer near the aortic arch. Within a few days there was complete resolution of ulceration. 

A 67-year-old man underwent laparotomy for a ruptured abdominal aortic aneurysm (20). Postoperatively he was treated with hemodialysis because of acute renal insufficiency. Hyperkalemia was treated with sodium polystyrene sulfonate, after which he developed ulceration of the colon and required a hemicolectomy because of intractable blood loss. 

Pancreatitis, any cause (P-AMY T) Pancreatic trauma (P-AMYT) Biliary tract disease (P-AMYT) - Intestinal obstruction (PtAMYT) Mesenteric infarction (P-Alv4Y(t Perforated peptic ulcer (P-AMYiT) Gastritis, duodenitis (P-AMY ) Ruptured aortic aneurysm Acute appendicitis Peritonitis Trauma... 

Anticoagulants and thrombolytics, particularly warfarin, can systemically embolize cholesterol particles from aortic atherosclerotic plaques to small arteries and arterioles, including renal arterioles. These agents remove or prevent thrombus formation over ulcerative plaques, causing emboh. Cholesterol emboli induce an inflammatory obliterative vascular response, causing renal ischemia. Purple discoloration of the toes and mottled skin over the legs are important clinical clues. 

Amarenco P, Duyckaerts C, Tzourio C, Henin D, Bousser MG Hauw JJ. (1992). The prevalence of ulcerated plaques in the aortic arch in patients with stroke. New Engl J Med 326, 221-225. 

The thoracic aorta may be affected by several different diseases, such as aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, aneurysms and traumatic injury. Any of these diseases may well be displayed in the axial slices, as well with post-processing (Takahashi and Stanford 2005). Volume rendering in particular is helpful in displaying the anatomical situation of the thoracic aorta after stent graft placement (Fig. 15.7). 

Complications Transverse myelitis, aortic rupture, and ulceration of the trachea and esophagus complicate bronchial artery infusion of chemotherapeutic agents. Fever, malaise, and chemical pneumonitis, in addition to skin necrosis, have also been reported. Hemoptysis has occurred in the absence of residual tumor, presumably related to the infusion itself. These complications have minimized the rewards of infusion. 

Most aortic dissections (ADs) occur in the thoracic aorta and extend into the abdominal aorta or even into the pelvis. An isolated dissection of the abdominal aorta is rare and should be distinguished from classic ADs. Penetrating atherosclerotic ulcers are considered as the origin of abdominal AD. 

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