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 thoracic pain and suspected pathologies of the aorta were reviewed for penetrating aortic ulcers. Pathoanatomical correlation was done by autopsy 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 criteria in CT were: 1. Hyperdense wall thickening on unenhanced CT scans (medial haematoma). 2.Displaced intimal calcifications outlining the lumen. 3. Small contrast-filled ulcer. 4. Absence of a contrast-filled false lumen. In 4 of the 9 cases the aorta ascendens was affected. The clinical presentation is that of an elderly patient with acute onset of thoracic pain and generalised atherosclerosis due to hypertension and nicotine abuse. Discussion: Penetrating ulcers with haematoma of the media are a special case of aortic dissection, with different features on unenhanced and enhanced CT scans.