Almohamed Ahmad, Takkem Saleh, Karaja Saja, Marina Sliman, Zoukar Sham, Rahhal Rema
Faculty of Medicine, Hama University, Hama.
Department of Cardiology, Hama National Hospital, Hama, Syria.
Ann Med Surg (Lond). 2024 Jun 10;86(10):6125-6128. doi: 10.1097/MS9.0000000000002262. eCollection 2024 Oct.
A penetrating aortic ulcer (PAU), which accounts for 2-7% of all acute aortic syndromes, is the ulceration of an aortic atherosclerotic plaque that passes through the internal elastic lamina and into the aortic medium. Although PAUs are frequently seen in the middle and lower descending thoracic aortas, it is rare for them to arise in the ascending aorta. Atherosclerotic vascular illnesses and isolated peripheral arterial illnesses are associated with similar risk factors, such as male sex, advanced age, a history of tobacco use, hypertension, hyperlipidemia, and coronary artery disease. Just 20-54% of people with PAU first exhibit symptoms, suggesting that the condition might sometimes present as an asymptomatic phenomenon.
A 60-year-old male came to the emergency department due to severe abdominal pain and abdominal contractures, which were diagnosed as mesenteric infarction with a relatively small infarcted intestinal segment. A part of the intestine was resected. Then he was referred to request a cardiac consultation to search for the source of the mesenteric infarction, which turned out to be an embolus.
The patient was referred to cardiac surgery to perform aortic grafting.
Aortic ulcer and mesenteric infarction together provide a challenging clinical picture that has to be recognized and treated right away. A high index of suspicion is necessary due to the possibility of fast deterioration, particularly in individuals who have risk factors like arteriosclerosis. Improving outcomes depends critically on early diagnostic imaging and intervention.
穿透性主动脉溃疡（PAU）占所有急性主动脉综合征的2%-7%，是一种穿透内弹力层进入主动脉中膜的主动脉粥样硬化斑块溃疡。虽然PAU常见于胸降主动脉中下段，但发生于升主动脉者罕见。动脉粥样硬化性血管疾病和孤立性外周动脉疾病与相似的危险因素相关，如男性、高龄、吸烟史、高血压、高脂血症和冠状动脉疾病。仅有20%-54%的PAU患者最初表现出症状，提示该疾病有时可能表现为无症状现象。
一名60岁男性因严重腹痛和腹部挛缩就诊于急诊科，被诊断为肠系膜梗死，梗死肠段相对较小。部分肠段被切除。随后他被转诊以寻求心脏会诊，以查找肠系膜梗死的病因，结果发现是栓子。
该患者被转诊至心脏外科进行主动脉移植手术。
主动脉溃疡和肠系膜梗死共同构成了具有挑战性的临床情况，必须立即识别并治疗。鉴于病情可能迅速恶化，尤其是对于有动脉硬化等危险因素的个体，高度怀疑很有必要。早期诊断性影像学检查和干预对于改善预后至关重要。
