Cardiology Department, Hospital General Universitari Vall d'Hebron, VHIR, CIBER-CV, Barcelona, Spain; Heart Institute, Quirónsalud-Teknon, Barcelona, Spain.
Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain.
Prog Cardiovasc Dis. 2020 Jul-Aug;63(4):488-495. doi: 10.1016/j.pcad.2020.05.006. Epub 2020 Jun 1.
Penetrating aortic ulcer (AU) is defined as localized disruption of the intimal layer of the aortic wall, resulting in a crater-like lesion outpouching from the vessel contour. AU is a generic term which encompasses a constellation of entities with different etiologies and prognoses and may be a complication of infective, inflammatory, traumatic, iatrogenic, atherosclerotic processes or intramural hematoma. One of the most challenging scenarios of AU for a differential diagnosis, but also for treatment implications, is when they are associated with acute aortic syndrome. Despite advances in the field of aortic disease, lack of consensus defining these lesions and the significant semantic confusion in the medical literature of the acronym PAU (for penetrating aortic ulcer but also for penetrating atherosclerotic ulcer) have given rise to controversy in guidelines and expert consensus, leading to the same treatment being recommended for entities with different etiology and prognosis. Moreover, in the medical literature, most diagnoses were mainly based on imaging techniques which identified AU regardless of clinical symptoms, surrounding imaging findings or dynamic morphologic changes. In this Review, we provide the latest insight into the differential diagnosis between AU, also called penetrating aortic ulcers, based on clinical context and the newest imaging characteristics to aid treatment decision-making.
穿透性主动脉溃疡 (AU) 定义为主动脉壁内膜层的局部破裂，导致病变从血管轮廓向外突出呈火山口样。AU 是一个通用术语，涵盖了不同病因和预后的一系列实体，可能是感染性、炎症性、创伤性、医源性、动脉粥样硬化过程或壁内血肿的并发症。对于 AU 的鉴别诊断，尤其是在治疗方面，最具挑战性的情况之一是当它们与急性主动脉综合征相关时。尽管主动脉疾病领域取得了进展，但缺乏定义这些病变的共识，以及医学文献中 PAU 缩写的语义混淆（既代表穿透性主动脉溃疡，也代表穿透性粥样硬化性溃疡），导致指南和专家共识存在争议，导致对不同病因和预后的实体采用相同的治疗方法。此外，在医学文献中，大多数诊断主要基于影像学技术，这些技术无论临床症状、周围影像学表现或动态形态学变化如何，均能识别 AU。在这篇综述中，我们根据临床背景和最新的影像学特征，提供了 AU（也称为穿透性主动脉溃疡）的最新鉴别诊断见解，以帮助治疗决策。
