Wetread Case 38 (Answer)
Hx: Chest Pain
Answer: Penetrating Atheromatous Ulcer (PAU)
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Original tweet:
Hx: Chest Pain
Answer: Penetrating Atheromatous Ulcer (PAU)
wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad
Original tweet:
L infrahilar mass - Does NOT obscure L heart border (blue) but does obscure aortic border (red - dashed lines being expected course and dark red line outlining mass).
Hilum overlay sign apparent as we still see hilar vessels through the mass (orange), ie mass is not the hilum
Hilum overlay sign apparent as we still see hilar vessels through the mass (orange), ie mass is not the hilum
How about the lateral? While there may be some artistic license here, it suggests enlargement of the mid-descending thoracic aorta
So of course we have the CT.
Luminal enlargement of the aorta where we expected it and, although a lot of thrombus, you can see contrast going beyond the normal luminal wall into the outpouching c/w a penetrating atheromatous ulcer (PAU)
Luminal enlargement of the aorta where we expected it and, although a lot of thrombus, you can see contrast going beyond the normal luminal wall into the outpouching c/w a penetrating atheromatous ulcer (PAU)
Aortic wall pathology is a bit confusing. IMHO the Radiology Assistant write-up is quiet good: radiologyassistant.nl/cardiovascular…
Here's my abbreviated take (people can add/correct if they would like). Pics courtesy of #Radiologyassistant
Here's my abbreviated take (people can add/correct if they would like). Pics courtesy of #Radiologyassistant
Intramural hematoma
-Isolated blood within the vessel wall with no connection to the inner lumen
- from internal tears of the vaso vasorum
- can enlarge
- can progress to aortic dissection upon extension into the lumen
-Isolated blood within the vessel wall with no connection to the inner lumen
- from internal tears of the vaso vasorum
- can enlarge
- can progress to aortic dissection upon extension into the lumen
Ulcerated plaque is just that, an ulcer in atheromatous plaque but it does NOT extend beyond the intimal layer
Penetrating Atheromatous Ulcer (PAU)
-Ulcerated plaque that has eroded into the inner elastic aortic wall
-Blood/hematoma within the wall connecting to the lumen
-Cause of most saccular aneurysms 🤔
-Usually desc thoracic aorta
-Medical trt (bp control) vs stenting if symptoms
-Ulcerated plaque that has eroded into the inner elastic aortic wall
-Blood/hematoma within the wall connecting to the lumen
-Cause of most saccular aneurysms 🤔
-Usually desc thoracic aorta
-Medical trt (bp control) vs stenting if symptoms
Aortic Dissection:
-Intimal injury w/ blood dissecting in/into the aortic wall
- look for intimal flap and IV contrast extending into the aortic wall
- Stanford Type A involves asc aorta/arch - trtd surgically
- Stanford Type B only desc aorta - trtd medically
-Intimal injury w/ blood dissecting in/into the aortic wall
- look for intimal flap and IV contrast extending into the aortic wall
- Stanford Type A involves asc aorta/arch - trtd surgically
- Stanford Type B only desc aorta - trtd medically
All of these entities together comprise Acute Aortic Syndrome (AAS)
-clinically identical
-although I allude to the dx from CXR, you NEED cross-sectional imaging!
-Type A vs B applies to all of these & guides trtment
-Type A➡️surgery
-Type B & asymptomatic➡️medical (bp control)
-clinically identical
-although I allude to the dx from CXR, you NEED cross-sectional imaging!
-Type A vs B applies to all of these & guides trtment
-Type A➡️surgery
-Type B & asymptomatic➡️medical (bp control)
