SILENT DISEASE- UNEXPECTED DISCOVERY OF PENETRATING AORTIC ULCER

Objective: The case report presents a patient with asymptomatic penetrating aortic ulcer (PAU) located in abdominal aorta which represents one of the causes of potential acute aortic syndrome. The primary objective is to emphasize the importance of watchfulness and extended vascular diagnostics in patients with significant risk factors of artery disease, like hypertension, chronic renal disease and atherosclerosis which gives the opportunity to save the patient from sudden, life-threatening complications. Design and method: The case report of a patient with cardiovascular risk factors in whom a Doppler ultrasound of the renal arteries revealed penetrating aortic ulcer, confirmed in angio-CT. The analysis of symptoms, diagnostic pathway and treatment. Results: An 84-year-old female patient with a history of long-lasting hypertension and peripheral artery disease was admitted to the Department of Internal Medicine and Hypertension from Emergency Unit due to headache, dizziness, tinnitus, and blood pressure over 214/74 mmHg. Laboratory tests revealed normocytic anemia (11,4 g/dL) and elevated creatinine levels (1,26 mg/dl, eGRF 43,1 ml/min). Carotid artery ultrasound showed significant stenosis of the left internal carotid artery (70–90%). Combined with a history of peripheral artery disease, hypertension, and high creatinine concentration, this implied additional diagnostic evaluation of the renal arteries. Doppler ultrasound revealed left renal artery stenosis and the suspicion of PAU. Then, an angio-CT was performed, which revealed an aneurysmal dilation up to 27 mm, starting 58 mm above the bifurcation of the aorta. At the level of the dilatation, there was a visible contrast enhancement, spreading towards the aortic protrusion - image suggesting atherosclerotic plaque ulcer or partially coagulated pseudoaneurysm. Antihypertensive and lipid-lowering treatment was modified, vascular surgeon consultation was made and then, the patient was referred to the Vascular Surgery Outpatient Clinic. Conclusions: While dealing with elderly patients burdened with cardiovascular risk factors, it is crucial to take into consideration the possibility of aortic disease presence which might be easily overlooked. This case demonstrated how foresight and curiosity facilitate early and meticulous diagnostics, revealing unexpected conditions and averting potential severe outcomes.