Penetrating atherosclerotic ulcers of the aorta

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Presentation transcript:

Penetrating atherosclerotic ulcers of the aorta James A. Harris, MD, Kostaki G. Bis, MD, John L. Glover, MD, Phillip J. Bendick, PhD, Anil Shetty, PhD, O.William Brown, MD Journal of Vascular Surgery Volume 19, Issue 1, Pages 90-99 (January 1994) DOI: 10.1016/S0741-5214(94)70124-5 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Thoracic aortogram shows distinct ulcer crater in distal descending thoracic aorta. B, CT scan shows ulcer has caused focal periaortic wall bulging. C, CT scan after 4 years shows progression to 7.2 cm saccular pseudoaneurysm with intraluminal thrombus. D, CT scan after 6 years, with good contrast enhancement, shows continued enlargement to 7.8 cm. Journal of Vascular Surgery 1994 19, 90-99DOI: (10.1016/S0741-5214(94)70124-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Thoracic aortogram shows bilobed ulcer in middescending thoracic aorta. B, Contrast-enhanced CT shows upper portion of bilobed ulcer. Also seen is adjacent atelectasis and pleural effusion. C, CT scan after 6 years shows progression of upper portion to 5.0 cm saccular pseudoaneurysm. D-F. D, Contrast-enhanced CT scan shows lower portion of bilobed ulcer at presentation. E, CT scan after 10 days shows lower portion of ulcer has begun to incorporate itself into aortic wall. F, CT scan after 6 years shows concentric aortic dilation to 5.0 cm fusiform aneurysm. Journal of Vascular Surgery 1994 19, 90-99DOI: (10.1016/S0741-5214(94)70124-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Thoracic aortogram shows bilobed ulcer in middescending thoracic aorta. B, Contrast-enhanced CT shows upper portion of bilobed ulcer. Also seen is adjacent atelectasis and pleural effusion. C, CT scan after 6 years shows progression of upper portion to 5.0 cm saccular pseudoaneurysm. D-F. D, Contrast-enhanced CT scan shows lower portion of bilobed ulcer at presentation. E, CT scan after 10 days shows lower portion of ulcer has begun to incorporate itself into aortic wall. F, CT scan after 6 years shows concentric aortic dilation to 5.0 cm fusiform aneurysm. Journal of Vascular Surgery 1994 19, 90-99DOI: (10.1016/S0741-5214(94)70124-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Digital subtraction angiogram shows penetrating ulcer on posterior surface of infrarenal aorta. B, Spin-echo MR (non-fat saturation) shows ulcer just distal to left renal vein.C-E. C, Resected aortic specimen with saccular dilation posteriorly. D, Cross section of resected specimen shows discrete ulcer margins with thrombus-lined pseudoaneurysm. E, Photomicrograph shows intima (In) and elastic fibers of media (Me) end abruptly, leaving thrombus (Th) and adventitia (Ad) to form wall of pseudoaneurysm. Atheroma is represented by At. Journal of Vascular Surgery 1994 19, 90-99DOI: (10.1016/S0741-5214(94)70124-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Digital subtraction angiogram shows penetrating ulcer on posterior surface of infrarenal aorta. B, Spin-echo MR (non-fat saturation) shows ulcer just distal to left renal vein.C-E. C, Resected aortic specimen with saccular dilation posteriorly. D, Cross section of resected specimen shows discrete ulcer margins with thrombus-lined pseudoaneurysm. E, Photomicrograph shows intima (In) and elastic fibers of media (Me) end abruptly, leaving thrombus (Th) and adventitia (Ad) to form wall of pseudoaneurysm. Atheroma is represented by At. Journal of Vascular Surgery 1994 19, 90-99DOI: (10.1016/S0741-5214(94)70124-5) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions