title: A blind spot in the eye of imaging technology: penetrating atheromatous ulcer.
abstract: Acute aortic syndrome (AAS) is a term that is used to describe a similar clinical profile that may have different underlying pathophysiological mechanisms. It includes classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer. We describe the case of a 77-year-old female who presented with syncope of unknown duration. The chest X-ray was suggestive of a widened mediastinum. The initial work-up with a computed tomography scan and transesophageal echocardiogram failed to diagnose a penetrating atherosclerotic ulcer. We discuss the importance of a high degree of clinical suspicion for AAS and the utility of different imaging technologies in making the diagnosis.
authors.affiliation: Department of Internal Medicine, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York 10019, USA. jr2902@columbia.edu
authors.forename: Jorge
authors.initials: J
authors.lastname: Romero
authors.forename: Arpit
authors.initials: A
authors.lastname: Shah
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Korniyenko
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D014057:Tomography, X-Ray Computed; D014456:Ulcer / Q000175:diagnosis / Q000209:etiology*