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.
ULPs are small saccular regions of contrast enhancement that protrude from the aortic lumen into the mural 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
- 1. Ming-Ting Wu, Yen-Chi Wang, Yi-Luan Huang, Ruey-Sheng Chang, Shang-Chieh Li, Pinchen Yang, Tung-Ho Wu, Kuan-Rau Chiou, Jer-Shyung Huang, Huei-Lung Liang, Huey-Ben Pan. Intramural Blood Pools Accompanying Aortic Intramural Hematoma: CT Appearance and Natural Course. (2011) Radiology. doi:10.1148/radiol.10101270
- 2. Eijun Sueyoshi, Yohjiro Matsuoka, Tatsuya Imada, Tomoaki Okimoto, Ichiro Sakamoto, Kuniaki Hayashi. New Development of an Ulcerlike Projection in Aortic Intramural Hematoma: CT Evaluation1. (2002) Radiology. doi:10.1148/radiol.2242011009
- 3. Ko JP, Goldstein JM, Latson LA, Azour L, Gozansky EK, Moore W, Patel S, Hutchinson B. Chest CT Angiography for Acute Aortic Pathologic Conditions: Pearls and Pitfalls. (2021) Radiographics : a review publication of the Radiological Society of North America, Inc. 41 (2): 399-424. doi:10.1148/rg.2021200055 - Pubmed
Related Radiopaedia articles
- acute aortic syndrome
- thoracic aortic aneurysm
- abdominal aortic aneurysm
- endovascular aneurysm repair (EVAR)
- reporting tips for aortic aneurysms
- aortic coarctation
- aortic pseudocoarctation
- cervical aortic arch
- interrupted aortic arch
- transposition of the great arteries
- variant anatomy of the aortic arch
- traumatic aortic injury