Penetrating Aortic Ulcer — EECC MCQ

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ModerateAortic DiseasePenetrating Aortic UlcerEECC

A 75-year-old man with severe atherosclerosis presents with sudden chest pain. CT aortography shows a focal crater-like ulceration in the descending aorta penetrating through the internal elastic lamina with surrounding intramural haematoma. What is this lesion?

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Correct answer: D — Penetrating aortic ulcer (PAU)

A penetrating aortic ulcer (PAU) is an atherosclerotic ulcer that erodes through the internal elastic lamina into the media. It is classified as part of the acute aortic syndrome spectrum alongside dissection and intramural haematoma. PAU most commonly occurs in the descending thoracic aorta in elderly patients with severe atherosclerosis. It can be complicated by intramural haematoma, pseudoaneurysm formation, rupture, or progression to frank dissection. Management depends on location: type A PAU (ascending aorta) typically requires emergency surgery; type B PAU (descending aorta) is managed medically with TEVAR reserved for complications (expansion, pain, rupture).

Reference: ESC (2024): Guidelines for the Management of Peripheral Arterial and Aortic Diseases