Ulcer-like projection (aorta)

Last revised by Yuranga Weerakkody on 20 Feb 2023

Ulcer-like projections (ULPs) are sometimes seen on contrast-enhanced CTs obtained in patients with a recent intramural aortic hematoma. They represent new intimal disruption and have a negative effect on prognosis. 

Ulcer-like projections are seen in approximately 40% of patients with intramural hematomas occurring at the time of intramural hematoma diagnosis or developing later (usually in the first month) 3.

Radiographic features


ULPs are small saccular regions of contrast enhancement that protrude from the aortic lumen into the intramural hematoma 3.  They communicate widely with the true lumen 1

As with intramural hematomas, they most commonly occur in the descending aorta.

In comparison with penetrating atherosclerotic ulcers where there is often irregular atheromatous disease, ulcer-like projections and intramural hematomas are typically associated with a smooth luminal surface 3.

Treatment and prognosis

Unlike intramural blood pools, ulcer-like projections frequently enlarge and adversely affect prognosis with subsequent dissection, aneurysm formation or aortic rupture 1-3

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Cases and figures

  • Figure 1: illustration
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  • Case 1
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