Możeńska Olga, Wojewódzki Michał, Wiligórska Diana, Wiligórska Natalia, Gil Robert J, Bil Jacek
Department Of Internal Medicine, Hypertension And Vascular Diseases, Warsaw Medical University, Warsaw, Poland.
Department Of Invasive Cardiology, Central Clinical Hospital Of The Ministry Of Interior And Administration, Warsaw, Poland.
Wiad Lek. 2020;73(7):1580-1582.
Penetrating aortic ulcer (PAU) is ulceration of an aortic atherosclerotic plaque penetrating through the internal lamina into the media. PAU is a rare condition and occurs in 2% - 7% of acute aortic syndromes (AAS); however, the actual incidence is unknown because of asymptomatic patients. One may treat it conservatively as well as surgically. We present a case of a 54-year-old man, who was admitted to hospital due to the exaggeration of exertional chest pain and persistent headaches. During coronary angiography, the suspicion of PAU was raised. Contrast-enhanced computed tomography confirmed the diagnosis. Transesophageal echocardiography showed bicuspid aortic valve with minimal calcification, the dilated ascending aorta, large atherosclerotic plaques in the aortic arch with ulceration (thickness: 5.0 - 5.5mm, diameter: 5 - 6 mm, depth: 3 - 4 mm), without intramural hematoma. Conservative treatment was chosen with uneventful 2-year follow-up. Although surgical management is advocated for patients with PAU type A, we demonstrated that type A PAU can be successfully treated conservatively as well.
穿透性主动脉溃疡（PAU）是主动脉粥样硬化斑块的溃疡，穿透内膜进入中膜。PAU是一种罕见疾病，在急性主动脉综合征（AAS）中占2% - 7%；然而，由于存在无症状患者，实际发病率尚不清楚。其治疗方式既可以是保守治疗，也可以是手术治疗。我们报告一例54岁男性病例，该患者因劳力性胸痛加重和持续性头痛入院。在冠状动脉造影期间，怀疑为PAU。增强计算机断层扫描证实了诊断。经食管超声心动图显示二叶式主动脉瓣伴轻度钙化、升主动脉扩张、主动脉弓有大的动脉粥样硬化斑块伴溃疡（厚度：5.0 - 5.5毫米，直径：5 - 6毫米，深度：3 - 4毫米），无壁内血肿。选择了保守治疗，随访2年情况良好。虽然对于A型PAU患者主张手术治疗，但我们证明A型PAU也可以通过保守治疗成功治愈。
