Penetrating 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-... 

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). 

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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