A Rare Case of Penetrating Atherosclerotic Ulcer of the Aorta

We are reporting a case of 66 year-old man who presented to a regional hospital with sudden onset of inter-scapular pain, radiating to anterior chest. Initial assessment was unremarkable except for high blood pressure and computed tomography (CT) of chest showing an intramural haematoma in the thoracic descending aorta. He was transferred to our institution for the medical management of his blood pressure and intramural haematoma of the aorta. A transoesophageal echocardiography confirmed the diagnosis but in addition demonstrated a penetrating atherosclerotic ulcer (PAU). Subsequently CT aortogram revealed a slow leak from the PAU. Endovascular repair with stent-grafting was urgently performed. He improved clinically and remained well on discharge. This case demonstrated that PAU, although rare and often under-recognised, is potentially life-threatening and should be considered in the evaluation of chest pain. Multi-modality imaging techniques can aid the diagnosis and guide appropriate and timely management.