Penetrating atherosclerotic ulcers of the thoracic aorta

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Penetrating atherosclerotic ulcers of the thoracic aorta

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Presentation transcript:

Penetrating atherosclerotic ulcers of the thoracic aorta Sajjad Hussain, MD, John L. Glover, MD, Robert Bree, MD, Phillip J. Bendick, PhD Journal of Vascular Surgery Volume 9, Issue 5, Pages 710-717 (May 1989) DOI: 10.1016/S0741-5214(89)70044-6 Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 CT scan of the chest of patient 1. The descending thoracic aorta appears dilated with an atheromatous ulcer (black arrow) and intramural hematoma (white arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 CT scan of the chest of patient 1 taken 4 weeks after discharge. There is dilatation of the aortic lumen and diminution in the size of the intramural hematoma (arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Admission chest radiograph of patient 2. Note the soft tissue density adjacent to the descending thoracic aorta (arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Thoracic aortogram of patient 2 shows an aneurysm of the descending thoracic aorta with a focal atheromatous ulcer (arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 CT scan of the chest of patient 3. There is an atheromatous ulcer in the descending thoracic aorta (black arrow) with an intramural hematoma (white arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Thoracic aortogram of patient 3 confirms the presence of a penetrating atheromatous ulcer (arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 CT scan of the chest of patient 3 taken approximately 11 weeks after discharge. The aortic lumen remains slightly dilated with resolution of the hematoma (arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Thoracic aortograms compare characteristic findings of penetrating ulcer (left) and type III dissection (right). Penetrating ulcers (arrow) are found in the descending thoracic aorta, distant from the origin of the left subclavian artery. Type III dissections generally begin as intimal lacerations beginning just distal to the origin of the subclavian artery (black arrow) and show a “false” or double lumen (white arrow). Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 CT scans compare characteristic findings of penetrating ulcer (left) and type III dissection (right). The penetrating ulcer appears as a local outpouching of contrast within the lumen (solid arrow) with surrounding intramural hematoma (arrowhead). The typical double lumen created by the dissected intima (arrow) is seen on the right. Journal of Vascular Surgery 1989 9, 710-717DOI: (10.1016/S0741-5214(89)70044-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions