Bosma Melissa S, Quint Leslie E, Williams David M, Patel Himanshu J, Jiang Qingmei, Myles James D
Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030, USA.
AJR Am J Roentgenol. 2009 Sep;193(3):895-905. doi: 10.2214/AJR.08.2073.
Aortic ulcerlike projections are focal, contrast-filled outpouchings projecting from the aortic lumen. Our aim was to document the CT findings and natural history of ulcerlike projections developing in patients with preexisting noncommunicating aortic dissection, including intramural hematoma or false lumen thrombosis.
By searching the radiology information system, we found 38 ulcerlike projections arising in an underlying noncommunicating aortic dissection that were identified at CT in 24 patients. Clinical factors were determined from patient records. CT scans were reviewed to determine aortic pathology type and appearance time of ulcerlike projections and to measure the diameters of the aorta and ulcerlike projections for comparison over time. Complications were defined as an increase of at least 20% in the diameters of the ulcerlike projections or aorta, the need for surgical repair, or both. Comparisons of ulcerlike projections with and without complications were performed using various statistical tests.
The underlying aortic disease of the 38 ulcerlike projections was intramural hematoma in 26, false lumen thrombosis in nine, and unknown in three. The mean time of ulcerlike projection appearance was 2.4 months (SD, 1.8) for intramural hematoma and 19.3 months (SD, 18.1) for false lumen thrombosis. Nine of the 28 ulcerlike projections with follow-up scans showed stability, size decrease, or resolution; 10 increased in size; and nine were incorporated into an expanded aortic lumen. Four of 36 ulcerlike projections with imaging or clinical follow-up (or both) required surgical repair. The only clinical or imaging feature significantly associated with the development of complications was false lumen thrombosis (p = 0.04).
Ulcerlike projections forming in noncommunicating dissections may enlarge over time, although they rarely require surgical repair. Given the potential for critical complications, these lesions should be followed with serial CT scans.
主动脉溃疡样突出是从主动脉管腔突出的局灶性、造影剂充盈的外突。我们的目的是记录在已存在的非交通性主动脉夹层患者中出现的溃疡样突出的CT表现和自然病程，包括壁内血肿或假腔血栓形成。
通过检索放射学信息系统，我们发现24例患者的CT检查中存在38个源于潜在非交通性主动脉夹层的溃疡样突出。临床因素从患者记录中确定。回顾CT扫描以确定主动脉病理类型、溃疡样突出的出现时间，并测量主动脉和溃疡样突出的直径以便随时间进行比较。并发症定义为溃疡样突出或主动脉直径至少增加20%、需要手术修复或两者兼具。使用各种统计检验对有并发症和无并发症的溃疡样突出进行比较。
38个溃疡样突出的潜在主动脉疾病中，26个为壁内血肿，9个为假腔血栓形成，3个不明。壁内血肿的溃疡样突出平均出现时间为2.4个月（标准差，1.8），假腔血栓形成为19.3个月（标准差，18.1）。28个有随访扫描的溃疡样突出中，9个显示稳定、大小缩小或消退；10个大小增加；9个融入扩大的主动脉管腔。36个有影像学或临床随访（或两者皆有）的溃疡样突出中有4个需要手术修复。与并发症发生显著相关的唯一临床或影像学特征是假腔血栓形成（p = 0.04）。
非交通性夹层中形成的溃疡样突出可能随时间增大，尽管很少需要手术修复。鉴于存在严重并发症的可能性，这些病变应通过系列CT扫描进行随访。
