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Penetrating atherosclerotic aortic ulcer: documentation by transesophageal echocardiography

Isidre Vilacosta, MD^a, José Alberto San Román, MD^*, Paloma Aragoncillo, MD^b, Joaquín Ferreirós, MD^c, Ramiro Mendez, MD^c, Catherine Graupner, MD^a, Elena Batlle, MD^a, Javier Serrano, MD^d, Angel Pinto, MD and José Manuel Oyonarte, MD

^a Department of Cardiology, Hospital Universitario de San Carlos, Madrid, Spain
^b Department of Human Pathology, Hospital Universitario de San Carlos, Madrid, Spain
^c Department of Radiology, Hospital Universitario de San Carlos, Madrid, Spain
^d Department of Vascular Surgery, Hospital Universitario de San Carlos, Madrid, Spain
^* Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
Department of Cardiac Surgery, Hospital Ruber Internacional, Madrid, Spain
Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain

View larger version (118K): [in a new window]   Figure 1 Patient 1. TEE scan showing penetrating aortic ulcers (arrows) in the descending thoracic aorta.

View larger version (97K): [in a new window]   Figure 2 Patient 1. TEE scan (top) and corresponding anatomic specimen (bottom) showing intramural aortic hematoma (asterisks) in the descending thoracic aorta. TR = thrombus.

View larger version (114K): [in a new window]   Figure 3 Patient 3. TEE scan in the longitudinal plane (L). A pseudoaneurysm (asterisk) with partial thrombosis (arrow) can be observed. AO = aorta; T = transverse.

View larger version (114K): [in a new window]   Figure 4 Patient 8. Top, TEE scans in the longitudinal plane. A thick, calcified, irregular flap can be seen. Bottom, Corresponding anatomical specimen. Dissection flap with multiple aortic ulcers. Arrows show entrance and reentrance tears. LF = false lumen; LV = true lumen.

View larger version (76K): [in a new window]   Figure 5 Top, TEE scan in the transverse plane showing a flap from a patient with a classic dissection. Compare with Figure 4, top. Bottom, Anatomic specimen of the descending thoracic aorta from a patient with a classic dissection. Compare with Figure 8, bottom. A thin dissection flap can be seen. Abbreviations as in Figure 4.

View larger version (79K): [in a new window]   Figure 6 Patient 12. Schematic drawing of a longitudinal section of the aorta and TEE scans in the transverse plane showing a dissection flap secondary to an aortic ulcer. A, Mural thrombus; B, aortic ulcer; C, localized aortic dissection.

View larger version (91K): [in a new window]   Figure 7 Patient 8. TEE scans in the transverse plane showing aortic dissection. Top, A large hemothorax (asterisk) can be seen. Bottom, Rupture of the false lumen wall (arrow). DPL = pleural effusion; other abbreviations as in Figure 4.

View larger version (58K): [in a new window]   Figure 8 Anatomic specimens from Patient 8. Top, Penetrating atherosclerotic aortic ulcer in the descending thoracic aorta. Bottom, Sagittal section.