Sala J, Esplugas E, Cequier A, Mauri J, Ruiz-Majoral A, Jara F, Barthe J
Servicio de Cardiología, Ciudad Sanitaria y Universitaria de Bellvitge, L'Hospitalet de Llobregat, Universidad de Barcelona.
Rev Esp Cardiol. 1994 Jun;47(6):362-7.
"Penetrating aortic ulcer", an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows haematoma formation within the aortic wall, is rarely considered in the differential diagnosis of patients with sudden onset of severe chest or back pain. It has been suggested that it is a pathologic process that involves elderly hypertensive patients with severe atherosclerosis and rarely has been observed in the ascending aorta.
To determine the characteristics of this process, 11 clinical, 2 hemodynamic, 3 angiographic and 4 surgical variables were compared between 10 consecutive patients with penetrating aortic ulcers and 20 matched patients with classic acute aortic dissection.
Clinical and hemodynamic variables were similar in both compared groups. In the group of patients with penetrating ulcer mean age was 58 +/- 6 years, previous hypertension was observed in 6 patients and the penetrating ulcer was located in the ascending aorta in 6 cases. In comparison to patients with aortic dissection, more angiographic projections were necessary to obtain the diagnosis in the group of patients with penetrating ulcer (2.4 +/- 0.8 vs 1.7 +/- 0.6; p < 0.05). In addition, the presence of angiographic aortic valve regurgitation was only observed in the group of patients with acute dissection (60% vs 0%; p < 0.001). Severe atherosclerosis was not present angiographically in any patient with penetrating ulcer.
Penetrating aortic ulcer can also affect middle age patients without severe atherosclerosis and is frequently observed in the ascending aorta. Its form of presentation and clinical characteristics are similar to classic aortic dissection. The lack of angiographic confirmatory evidence of dissection with suggestive clinical history, should raise the possibility of penetrating aortic ulcer.
“穿透性主动脉溃疡”是一种伴有溃疡形成的动脉粥样硬化病变，溃疡穿透内弹力层并导致主动脉壁内血肿形成，在突发严重胸痛或背痛患者的鉴别诊断中很少被考虑。有人认为这是一种涉及老年高血压且伴有严重动脉粥样硬化患者的病理过程，在升主动脉中很少见。
为确定这一过程的特征，对10例连续性穿透性主动脉溃疡患者和20例匹配的典型急性主动脉夹层患者的11项临床、2项血流动力学、3项血管造影和4项手术变量进行了比较。
两组的临床和血流动力学变量相似。穿透性溃疡患者组的平均年龄为58±6岁，6例患者有既往高血压史，6例患者的穿透性溃疡位于升主动脉。与主动脉夹层患者相比，穿透性溃疡患者组需要更多的血管造影投照来确诊（2.4±0.8对1.7±0.6；p<0.05）。此外，血管造影显示主动脉瓣反流仅在急性夹层患者组中观察到（60%对0%；p<0.001）。在任何穿透性溃疡患者的血管造影中均未发现严重动脉粥样硬化。
穿透性主动脉溃疡也可影响无严重动脉粥样硬化的中年患者，且常见于升主动脉。其表现形式和临床特征与典型主动脉夹层相似。对于有提示性临床病史但缺乏血管造影证实的夹层证据时，应考虑穿透性主动脉溃疡的可能性。
