A 74-year-old hypertensive man undergoes CT aortography for chest discomfort. The descending thoracic aorta shows a focal contrast-filled outpouching projecting beyond the expected lumen contour, arising from a calcified plaque, with adjacent wall thickening. No flap is present. What is the diagnosis?
- A Traumatic aortic pseudoaneurysm
- B Myocotic aneurysm
- C Penetrating atherosclerotic ulcer ✓
- D Ductus diverticulum
Correct answer: C. Penetrating atherosclerotic ulcer
Explanation
A penetrating atherosclerotic ulcer occurs when an atheromatous plaque ulcerates through the internal elastic lamina into the media, producing a focal contrast outpouching beyond the lumen on a background of heavy calcified plaque, classically in the descending thoracic aorta of an elderly hypertensive patient. Traumatic pseudoaneurysm occurs at the isthmus after deceleration injury in younger patients. Ductus diverticulum is a smooth medial bulge at the isthmus without plaque ulceration.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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