Habis M, Pouillart F, Becquemin J P, Guéret P
Fédération de cardiologie, Hôpital Henri-Mondor, Créteil.
Arch Mal Coeur Vaiss. 1996 Jul;89(7):907-11.
The authors report a case of penetrating atheromatous ulceration of the descending thoracic aorta complicated by a haemothorax. Atheromatous ulceration of the aorta is usually observed in elderly hypertensives. It is caused by rupture of the internal elastic layer under an atheromatous plaque extending into the media and resulting in a parietal haematoma of the aorta. Clinically, the differential diagnosis is that of a dissection of the aorta or of fissuration of an atheromatous aneurysm. Nowadays, the investigations of choice are a chest CT scan with injection of contrast and MRI. Transoesophageal echocardiography excludes dissection of the aorta but may miss a direct image of penetrating ulcer when the latter is of small size. The treatment of choice is not established because the natural history of the condition is not well known. Penetrating ulcer would seem to progress slowly to development of an aortic aneurysm. Surgery is mainly reserved for forms complicated by painful recurrences or rupture and for cases involving the ascending aorta.
作者报告了一例降主动脉穿透性动脉粥样硬化溃疡并发血胸的病例。主动脉粥样硬化溃疡通常见于老年高血压患者。它是由延伸至中膜的动脉粥样硬化斑块下的内弹性层破裂导致主动脉壁血肿引起的。临床上，鉴别诊断包括主动脉夹层或动脉粥样硬化性动脉瘤破裂。如今，首选的检查方法是注射造影剂的胸部CT扫描和MRI。经食管超声心动图可排除主动脉夹层，但当穿透性溃疡较小时可能无法直接显示。由于该病的自然病程尚不清楚，因此尚未确定首选治疗方法。穿透性溃疡似乎会缓慢发展为主动脉瘤。手术主要适用于并发疼痛复发或破裂的病例以及累及升主动脉的病例。
