PENETRATING AORTIC ULCERS - CLINICAL AND IMAGING FINDINGS AND DIFFERENTIAL-DIAGNOSIS

Purpose: The aim was to present clinical findings and imaging criteria for patients with aortic ulcers of the thoracic aorta. Methods: From 1993 to 1996 computed tomography of patients suffering from acute thor acic pain and suspected pathologies of the aorta were reviewed for pen etrating aortic ulcers. Pathoanatomical correlation was done by autops y in three cases and with intraoperative inspection in two cases. MRI was available in three patients and angiography in 5 patients. Results : 9 patients with aortic ulcers could be identified. The imaging crite ria in CT were: 1. Hyperdense wall thickening on unenhanced CT scans ( medial haematoma). 2.Displaced intimal calcifications outlining the lu men. 3. Small contrast-filled ulcer. 4. Absence of a contrast-filled f alse lumen. In 4 of the 9 cases the aorta ascendens was affected. The clinical presentation is that of an elderly patient with acute onset o f thoracic pain and generalised atherosclerosis due to hypertension an d nicotine abuse. Discussion: Penetrating ulcers with haematoma of the media are a special case of aortic dissection, with different feature s on unenhanced and enhanced CT scans.