Ulcerlike projections: a precursor angiographic sign to thoracic aortic dissection

New Development of an Ulcerlike Projection in Aortic Intramural Hematoma: CT Evaluation

“…Ulcerlike projection was first described in 1965 as a defect in the intima leading to a clotted second channel, and it has been recognized as one of the radiologic findings in aortic dissection (1)(2)(3)(4)(5). At CT and angiography, the ulcerlike projection appears as a localized blood-filled pouch protruding into the thrombosed lumen of the aorta, showing the same degree of contrast enhancement as the aortic lumen.…”

“…At CT and angiography, the ulcerlike projection appears as a localized blood-filled pouch protruding into the thrombosed lumen of the aorta, showing the same degree of contrast enhancement as the aortic lumen. On MR images, it appears as an area of signal void owing to blood flow (1)(2)(3)(4)(5)13). Investigators in recent studies (4,5,9,13) have suggested that the ulcerlike projection can be seen in the three aortic diseases previously mentioned.…”

“…Ulcerlike projections have usually been considered to represent the site of an intimal disruption, such as an intimal tear and penetrating atherosclerotic ulcer (PAU) (1)(2)(3)(4)(5).…”

Coexistent True Aortic Aneurysm as a Cause of Acute Aortic Dissection

“…Intimal tear of the AAD was suspected because of the presence of the proximal or distal ends of the patent segment of partial thrombosed type AAD 3 or ULP of the thrombosed type AAD. 5,6 Diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dl, non-fasting plasma glucose ≥200 mg/dl on 2 occasions, or current antidiabetic medications. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medication.…”

An analysis of initial and follow-up CT findings in intramural hematoma, aortic double-lumen dissection, and mixed type lesions

“…Mitsui Memorial Hospital, Tokyo, Japan angiographic studies in 1980 (5), suggested that the initial lesion of aortic dissection might be a localized tear in the media with the formation of an ulcer and subsequent dissection along the media. According to a recent histological analysis of intramural hematomas and aortic dissections, the initial event in both types of pathology developed in the outer third of the media alongside the vasa vasorum (6).…”