Ulcer-like projections result from a new intimal disruption in the area of a pre-existing aortic intramural hematoma. They appear as saccular lesions that extend from the aortic lumen into the intramural hematoma, beyond the expected area of the intima. The involved aortic segment usually lacks atherosclerotic changes and the associated intramural hematoma typically has a smooth lumen-wall interface (in contrast to the irregular or undulating interface typically observed in penetrating atherosclerotic ulcers).