Korean J Thorac Cardiovasc Surg.  2003 Jan;36(1):30-34.

Acute Type A Aortic Dissection Mimicking Penetrating Atherosclerotic Ulcer

• Ahn H
• Kwak JG
• Choi JS

Abstract

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiography with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, hemopericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.

Keyword

Aortic aneurysm, dissecting; Ulcer; Intramural hematoma

MeSH Terms

Aged
Angiography
Aorta
Aorta, Thoracic
Aortic Diseases
Aortic Rupture
Brachiocephalic Trunk
Chest Pain
Diagnosis
Diagnosis, Differential
Echocardiography
Emergencies
Female
Hematoma
Humans
Magnetic Resonance Imaging
Mediastinum
Natural History
Nausea
Pericardial Effusion
Pleural Cavity
Tunica Media
Ulcer*
Vomiting