Penetrating Aortic Ulcer and Intramural Hematoma
Penetrating Aortic Ulcer
The aorta is the largest artery (blood vessel) in the body and carries oxygen-rich blood away from the heart to all parts of the body. A penetrating aortic ulcer is a rare condition that most commonly develops in the descending aorta. It occurs when plaque in the aorta from atherosclerosis, commonly referred to as hardening of the arteries, forms ulcers that penetrate the aortic wall. By damaging the aortic wall, penetrating ulcers put patients at risk for aortic dissection or rupture. Although a penetrating aortic ulcer may resemble an aortic aneurysm or dissection on imaging scans, its cause, atherosclerosis, is what makes it different. Intramural hematoma (IMH) is a collection of blood in the wall of the thoracic aorta. Is it likely a precursor to aortic dissection if not managed quickly.
Factors that can increase an individual's risk of developing a penetrating aortic ulcer and IMH include:
- A history of smoking
Patients suffering from penetrating aortic ulcers may often experience the same symptoms as those with aortic dissection such as chest or back pain, or both.
Diagnosis of a penetrating ulcer may be done through one of the following tests:
- CT scan
- Transesophageal echocardiography (TEE)
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Treatment options for penetrating aortic ulcers and IMH include medication therapy and surgical or endovascular repair. The presence of a deeply penetrating ulcer may indicate the need for surgical or endovascular repair. As with aortic dissection, medications such as beta blockers and nitroprusside may be prescribed to reduce the heart rate and lower blood pressure to prevent the condition from worsening and to stabilize blood pressure prior to surgery. Surgical or endovascular interventions will be recommended depending on the location and severity of the ulcer. The presence of a deeply penetrating ulcer may indicate the need for immediate surgical or endovascular repair. For patients treated with medications, follow up imaging tests will be necessary to monitor growth of the ulcer. If the diameter of the aorta increases, surgical repair or endovascular surgery to place a stent graft may be recommended.
Urgent blood pressure management is indicated to reduce the risk of progression to an aortic dissection. Surgical treatment with aortic stent grafts may be required if symptoms are not controlled with blood pressure medication or if the hematoma expands.