• Journal of Chest Surgery
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• v.41 no.5
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• pp.647-650
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• 2008

Aortic disease usually recurs after aortic surgery in the form a new aneurysm distal to the previous operation site, and finding a penetrating atherosclerotic ulcer proximal to the previous operation site has rarely been reported. We report here on a case of successful patch repair of a ruptured penetrating ulcer in the distal aortic arch, and this developed late after replacement of the descending thoracic aorta.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.30-34
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• 2003

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiographic with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, heompericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.704-707
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• 2007

Penetrating atherosclerotic ulcer involving the aortic arch has rarely been reported on in the literature. Acute rupture of a penetrating atherosclerotic ulcer involving the distal arch and the proximal descending thoracic aorta was found in a 78-year-old male, and he originally presented with acute-onset shoulder pain and hoarseness. Patch repair of the perforated arch and the proximal descending thoracic aorta was successfully done under total circulatory arrest.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.872-875
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• 2004

The treatment modalities of the intramural hematoma (IMH) remain controversial. Nowadays, the IMH of the descending thoracic aorta is generally classified in the medical treatment category. We describe a patient with IMH of the descending thoracic aorta who received the medical treatment. During the follow-up, we speculated that the IMH had been aggravated leading to an aortic rupture including hemothorax. Therefore, we performed an emergency operation. Contrary to our expectations, operative findings showed a well-organized aortic wall and serous pleural effusion. The exact diagnosis was IMH of the descending thoracic aorta with penetrating atherosclerotic ulcer (PAU). This case reminded us of the importance of accurate diagnosis and proper treatment.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.365-368
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• 2013

We report a case of concurrent saccular aneurysms caused by a penetrating atherosclerotic ulcer of the thoracic and abdominal aorta that were successfully treated by staged endovascular repair. Even though surgical open repair or endovascular repair is the treatment option, use of endovascular repair is now accepted as an alternative treatment to surgery in selected patients. To prevent contrast medium-induced nephropathy and spinal cord ischemia caused by a simultaneous endovascular procedure, a saccular aneurysm of the descending thoracic aorta was excluded by stent graft, followed by the placement of a bifurcated stent graft in the infrarenal abdominal aorta one month later.