Ulcerlike lesions of the aorta: Imaging features and natural history

PURPOSE: To document the natural history of ulcerlike aortic lesions and de termine whether any computed tomographic (CT) features predict outcome. MATERIALS AND METHODS: CT scans from 1994 to 1998 that depicted an ulcerlik e aortic lesion were retrospectively evaluated. Features evaluated included lesion and aortic size and intramural hematoma. Initial CT findings were c orrelated with clinical data and subsequent CT findings. RESULTS: There were 56 lesions in 38 patients. Follow-up (mean, 18.4 months ) CT scans were available for 33 lesions. Stability of the lesion and adjac ent aorta was noted in 21 lesions. Two lesions were unchanged, although ass ociated intramural hematoma regressed over 1-2 months. Ten lesions showed m ild to moderate increase in aortic diameter (mean follow-up, 19.8 months) e ither with (seven lesions) or without (one lesion) increase in size of the lesion or with incorporation of the lesion into the aortic wall contour (tw o lesions). Of all 56 lesions, 37 were clinically stable, two were associat ed with recurrent chest and/or back pain, eight underwent surgical resectio n or stent placement, and two were in patients who died. Seven lesions were in patients lost to follow-up. No initial CT feature was predictive of CT outcome, although lack of pleural effusion correlated with clinical stabili ty. CONCLUSION: Most ulcerlike aortic lesions are asymptomatic and do not enlar ge. About one-third of lesions progress, generally resulting in mild interv al aortic enlargement.