A penetrating ulcer, also called penetrating atherosclerotic ulcer, is a rare condition that most commonly develops in the descending aorta. It occurs when plaque in the aorta (from atherosclerosis) forms ulcers that penetrate the aortic wall. By damaging the aortic wall, penetrating ulcers put patients at risk for aortic dissection or rupture. Although the appearance of a penetrating ulcer may resemble an aortic aneurysm or dissection on imaging scans, its cause, atherosclerosis, is unique.
Patients who develop a penetrating ulcer usually have atherosclerosis (hardening of the arteries), hypertension (high blood pressure), and back or chest pain. Many are current or former smokers. Diagnosis of a penetrating ulcer may be done through CT scan, MRI, and or transesophageal echocardiography (TEE).
Although classic aneurysms located in the thoracic aorta are not usually at high risk of rupture, penetrating ulcers may require surgery. Most commonly, this disease is treatable with minimally invasive endovascular stent procedures.