Initial Diagnosis of Penetrating Aortic Ulceration in Conventional Radiography: A Case Series

Einleitung Penetrating aortic ulceration (PAU) is an emergency diagnosis under the umbrella of acute aortic syndrome. It may present as asymptomatic in up to 80% of cases, but requires stringent monitoring and surgical treatment due to significant cardiovascular comorbidity. [1] We reported four cases in which the initial diagnosis of PAU was identified in conventional projection radiography.

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Anamnese Four patients received posteroanterior and lateral projections of chest radiographs: two patients were x-rayed due to previous history of malignant neoplasm, one patient was screened pre-surgery in an orthopedic setting and one patient was x-rayed on the suspicion of cardiomyopathy. All patients were asymptomatic at the time of the x-ray and had no history of vascular disease. In all four cases three typical features were identified: 1) paraaortic convex or spherical opacity; 2) irregularity of the aortic outline; 3) biconvex lucency within the aortic arch. Chest CT confirmed the diagnosis of PAU without acute rupture. One patient received emergency open aortic surgery (prosthetic aortic graft), two patients received elective minimally invasive endovascular surgery (TEVAR stent graft) and one patient was referred to the cardiovascular department and received antihypertensive medication. All patients were stable and asymptomatic at a median follow-up of n=327 days.

Diskussion Penetrating aortic ulceration remains a challenging diagnosis, however it is possible to identify three key signs in elective conventional projection radiography: paraaortic opacity, aortic outline irregularity and aortic arch lucency. Early identification of PAU is crucial to providing early monitoring, conservative treatment and surgery if needed [2].

Publikationsverlauf

Artikel online veröffentlicht:
12. April 2024

• Literatur

• 1 Weiss S. et al. Cardiovascular morbidity and mortality after aortic dissection, intramural hematoma, and penetrating aortic ulcer. J Vasc Surg. 2019
• 2 Mehta CK. et al. Management of acute aortic syndromes from initial presentation to definitive treatment. Am J Emerg Med. 2022