Asymptomatic Penetrating Aortic Ulcer: Benign or Malignant?

We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patients young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.

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Late Presentation of Penetrating Ulcers at the Ascending Aorta Associated With Intra-Mural Haematoma

Journal of Surgical Case Reports and Images ◽

10.31579/2690-1897/015 ◽

2020 ◽

Vol 3 (2) ◽

pp. 01-05

Author(s):

Ayman Kenawy

Keyword(s):

High Risk ◽

Disease Progression ◽

Surgical Repair ◽

Surgical Intervention ◽

Late Presentation ◽

Ascending Aorta ◽

Chronic Type ◽

Penetrating Aortic Ulcer ◽

Good Outcome ◽

Pseudo Aneurysm

The combined pathology of intra-mural haematoma (IMH) and penetrating aortic ulcer (PAU) represents disease progression of the PAU with high risk for further progression to either rupture or pseudo-aneurysm formation, and hence surgical intervention should be offered once diagnosis is made regardless of the presentation. We present a 70-year-old fit lady with chronic type A IMH associated with multiple PAUs, diagnosed incidentally, the patient underwent urgent surgical repair with good outcome.

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Faculty Opinions recommendation of Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725232097.793501480 ◽

2014 ◽

Author(s):

John Augoustides

Keyword(s):

Expert Consensus ◽

Intramural Haematoma ◽

Type B ◽

Penetrating Aortic Ulcer

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A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

SAGE Open Medical Case Reports ◽

10.1177/2050313x211037784 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110377

Author(s):

Yasuhito Nakamura ◽

Kiyoshi Doi ◽

Syojiro Yamaguchi ◽

Etsuji Umeda ◽

Osamu Sakai ◽

...

Keyword(s):

Rare Case ◽

Aortic Wall ◽

Aortic Rupture ◽

Ascending Aorta ◽

Bleeding Site ◽

Penetrating Aortic Ulcer ◽

Postoperative Course ◽

Life Threatening ◽

Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

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