Pathogenesis in acute aortic syndromes: Aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer

Patients presenting with acute aortic syndromes usually have a similar clinical profile: aortic pain with coexisting history of hypertension. However, the pathophysiology and appearance of these syndromes differ in many ways. The classic aortic dissection involves an intimomedial flap, which traverses the aortic lumen. Intramural hematoma and penetrating aortic ulcer are nonflap lesions, with intramural hematoma showing no intimal disruption and penetrating aortic ulcer showing an ulcer at the atherosclerotic plaque burrowing through the aortic intima and media. Radiologic evaluation plays a key role in assessing patients with acute disease of the aorta, and imaging techniques should aim both to diagnose the condition and to characterize the underlying pathology.