Emergent surgical repair of a ruptured ascending penetrating aortic ulcer in a 33-year-old male resulted in successful recovery and survival at 3-month follow-up.
Case Report (n=1)
No
This case highlights the importance of maintaining clinical suspicion for acute aortic pathology in young adults with hypertension and the critical role of rapid CTA and systems-based coordination for emergent surgical repair.
Penetrating aortic ulcer (PAU) is a rare but highly lethal manifestation of acute aortic syndrome (AAS), most commonly seen in elderly patients with advanced atherosclerosis. Ascending aortic involvement is particularly uncommon but carries a high risk of rupture, hemopericardium, and cardiac tamponade. We present the case of a 33-year-old male with longstanding poorly controlled hypertension who presented to a community hospital with chest pain and syncope. Initial evaluation suggested acute coronary syndrome; however, computed tomography angiography revealed rupture of a penetrating ascending aortic ulcer with intramural hematoma and hemopericardium. The patient underwent prompt helicopter transfer to a tertiary care center and emergent surgical repair. He had an excellent postoperative recovery and remains well on follow-up. This case highlights the importance of maintaining clinical suspicion for acute aortic pathology, the diagnostic utility of computed tomography angiography, and the critical role of rapid systems-based coordination in achieving favorable outcomes in this high-mortality condition.
Patel et al. (Sun,) conducted a case report in Ruptured Penetrating Aortic Ulcer with Hemopericardium (n=1). Emergent surgical repair (median sternotomy and ascending aorta replacement) was evaluated. Emergent surgical repair of a ruptured ascending penetrating aortic ulcer in a 33-year-old male resulted in successful recovery and survival at 3-month follow-up.