Penetrating atherosclerotic ulcer of the aorta

Purpose: To describe a case of penetrating atherosclerotic ulcer of the aor ta with a review of its natural history, diagnosis and management. Case Report: An elderly patient with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to the back. The electrocardiogram showed left ventricular hypertrophy; the c hest radiograph revealed mediastinal widening. Computed tomography was susp icious for a mediastinal hematoma without aortic dissection. Transesophagea l echocardiography was also negative for dissection. An aortogram revealed a penetrating atherosclerotic ulcer of the descending thoracic aorta. The p atient underwent successful resection and repair of the lesion. Conclusions: Penetrating atherosclerotic ulcer of the aorta is a potentiall y lethal lesion that must be promptly diagnosed and treated.