A penetrating aortic ulcer rapidly evolving into aortic dissection in a patient presenting with respiratory tract infection to the emergency department: an acute aortic
syndrome case report
Dublin Core
Title
A penetrating aortic ulcer rapidly evolving into aortic dissection in a patient presenting with respiratory tract infection to the emergency department: an acute aortic
syndrome case report
syndrome case report
Subject
Penetrating atherosclerotic ulcer, Aortic dissection, Acute aortic syndrome, Intramural hematoma, Aortic
lesion, Emergency medicine
lesion, Emergency medicine
Description
Abstract
Background Penetrating aortic ulcers (PAU) are life-threatening conditions which derive from severely advanced
atherosclerotic lesions of the aorta. The clinical course is unpredictable; thus clinical vigilance should be maintained. It
is very challenging to separate PAU from co-existing AAS as predisposing factors and findings overlap.
Case presentation Case of 58-year-old gentleman, who presented for atypical chest pain in the setting of respiratory
tract infection. Computed Tomographic angiography (CTA) of the chest showed a large PAU and intramural
hematoma which rapidly progressed into an acute aortic dissection in the emergency department. Close follow up
with cardiac point of care ultrasound one hour later detected an intimal flap which was not initially present on CTA.
Patient underwent surgical aortic graft replacement and had an uneventful in-hospital stay.
Discussion This case underlines the importance of broadening differential diagnoses in atypical presentations in
patients with risk factors. Prompt intervention and careful management are imperative to optimize patient outcomes
and prevent complications of aortic lesions. Cardiac point of care ultrasound can help in detecting progression of
dynamic atherosclerotic diseases such as acute aortic syndrome.
Keywords Penetrating atherosclerotic ulcer, Aortic dissection, Acute aortic syndrome, Intramural hematoma, Aortic
lesion, Emergency medicine
Background Penetrating aortic ulcers (PAU) are life-threatening conditions which derive from severely advanced
atherosclerotic lesions of the aorta. The clinical course is unpredictable; thus clinical vigilance should be maintained. It
is very challenging to separate PAU from co-existing AAS as predisposing factors and findings overlap.
Case presentation Case of 58-year-old gentleman, who presented for atypical chest pain in the setting of respiratory
tract infection. Computed Tomographic angiography (CTA) of the chest showed a large PAU and intramural
hematoma which rapidly progressed into an acute aortic dissection in the emergency department. Close follow up
with cardiac point of care ultrasound one hour later detected an intimal flap which was not initially present on CTA.
Patient underwent surgical aortic graft replacement and had an uneventful in-hospital stay.
Discussion This case underlines the importance of broadening differential diagnoses in atypical presentations in
patients with risk factors. Prompt intervention and careful management are imperative to optimize patient outcomes
and prevent complications of aortic lesions. Cardiac point of care ultrasound can help in detecting progression of
dynamic atherosclerotic diseases such as acute aortic syndrome.
Keywords Penetrating atherosclerotic ulcer, Aortic dissection, Acute aortic syndrome, Intramural hematoma, Aortic
lesion, Emergency medicine
Creator
Victoria Al Karaki1* and Aed Saab1
Source
https://doi.org/10.1186/s12245-024-00724-z
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Victoria Al Karaki1* and Aed Saab1, “A penetrating aortic ulcer rapidly evolving into aortic dissection in a patient presenting with respiratory tract infection to the emergency department: an acute aortic
syndrome case report,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12449.
syndrome case report,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12449.