Penetrating aortic atherosclerotic ulcer

Case contributed by Dr Talal F M Abdullah


Chest discomfort, uncontrolled hypertension, hypercholesterolaemia and widened mediastinum on CXR. Echo by ER doctor showed a pericardial effusion.

Patient Data

Age: 65
Gender: Male

Aortic arch contour deformity with a triangular contrast dense opacity suggestive of an ulcerated plaque and impending dissection.

Dense pericardial effusion, consistent with hemopericardium.

No intimal flap.

Case Discussion

CT aortogram (abdominal aorta not shown) shows a contour deformity at the ascending aorta/arch junction that opacifies with contrast mostly likely representing a non-calcified ulcerated atherosclerotic plaque. Dense pericardial effusion extending beyond the anatomic boundaries (into around the arch) in keeping with acute leaking.  No dissection intimal flap seen on this study.

Later a  second assessment with echocardiography by the cardiologist revealed a dissection flap - Stanford A (half hour after the CT) and clotted blood in the pericardium.

This is within the spectrum of acute aortic syndrome.


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Case information

rID: 58029
Published: 27th Jan 2018
Last edited: 28th Jan 2018
System: Vascular
Inclusion in quiz mode: Included

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