Penetrating Aortic Ulcer and Intramural Hematoma
نویسندگان
چکیده
A ortic intramural hematoma (IMH) is an acute aortic disease, defined by the presence of hemorrhage within the aortic wall, and no evidence of intimal tear. The penetrating aortic ulcer (PAU) is a chronic aortic condition, defined by an ulcer-like disruption of the intima maturing within the aortic lumen. IMH usually presents with a smooth intima and some degree of atherosclerosis, whereas PAU is associated with systemic atherosclerosis and, often, a thickened intima with craters (Figure 1). Stanson et al accurately described PAU as an ulceration of an atheromatous plaque that disrupts the internal elastic lamina and allows hematoma formation within the media of the aortic wall.1 PAU can be the cause of IMH, which may evolve as aortic dissection (AD). IMH is distinguished from AD by the absence of an intimal flap.2 The Stanford classification defines IMH similarly to AD: IMH type A involves the ascending aorta and arch, whereas IMH type B (IMHB) is localized only in the descending thoracic aorta.3 The incidence of IMH and PAU is still unclear. IMH has been reported in the literature with an incidence varying between 2% and 45% (approximately 12% among all acute dissections) based on the International Registry of Acute Aortic Dissection (IRAD).4,5 There is little evidence about the incidence of PAU, although rates of 2.3% to 7.6% in symptomatic patients have been described.6 In patients admitted with acute AD, an ulcer was identified in 7.6%, which could implicate that PAU causes dissection more often than previously thought.6
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