title: [Acute penetrating atherosclerotic ulcers in aortic arch: differential diagnosis of chest pain].
abstract: Penetrating atherosclerotic ulcers (PAU) represent a pathological phenomenon in which ulceration of atheromatous lesions of the aorta penetrates the internal elastic lamina, reaching the middle muscular layer. These ulcers are more common in the descending thoracic aorta, being rare in the ascending aorta. The differential diagnosis between PAU and other entities of acute aortic syndromes (AAS) becomes difficult. The diagnosis of this disease is made through imaging studies: multidetector computed tomography (MDCT), magnetic resonance (MR) or transesophageal echocardiography (TEE). After diagnosis, the PAU of the ascending aorta should be treated surgically in an emergency context. In this paper the authors report a case of PAU in the aortic arch in a 84 years old patient admitted to the emergency room for chest pain. In this context a review of the natural evolution of this entity is made, with emphasis on diagnostic imaging modalities used for its characterization as well as their treatment options.
authors.affiliation: Serviços de Cardiologia e Radiologia do Centro Hospitalar de Tondela-Viseu. Viseu, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rodrigues
authors.forename: Carla
authors.initials: C
authors.lastname: Ribeiro
authors.forename: Luis Ferreira
authors.initials: LF
authors.lastname: Santos
authors.forename: Davide
authors.initials: D
authors.lastname: Moreira
authors.forename: Pedro
authors.initials: P
authors.lastname: Ferreira
authors.forename: João
authors.initials: J
authors.lastname: Pipa
authors.forename: Ilídio
authors.initials: I
authors.lastname: Beirão
authors.forename: Oliveira
authors.initials: O
authors.lastname: Santos
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D014456:Ulcer / Q000150:complications / Q000175:diagnosis*