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Intramural haematoma and penetrating aortic ulcer -outcome and treatment modalities: Report of four cases

Končar Igor (Klinika za vaskularnu i endovaskularnu hirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Davidović Lazar (Klinika za vaskularnu i endovaskularnu hirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Čolić Momčilo (Klinika za vaskularnu i endovaskularnu hirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Dragaš Marko (Klinika za vaskularnu i endovaskularnu hirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Ilić Nikola (Klinika za vaskularnu i endovaskularnu hirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Menković Nemanja (Medicinski fakultet, Beograd + Služba za radiologiju, Klinički centar Srbije, Beograd)
Vučković Maja (Medicinski fakultet, Beograd + Služba za radiologiju, Klinički centar Srbije, Beograd)
Kalimanovska-Oštrić Dimitra (Medicinski fakultet, Beograd + Klinika za kardiologiju, Klinički centar Srbije, Beograd)
Cvetković Slobodan (Klinika za vaskularnu i endovaskularnu hirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Kostić Dušan (Klinika za vaskularnu i endovaskularnu hirurgiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)

Introduction. Intramural haematoma (IMH) and penetrating aortic ulcers (PAU) are the frequent cause of acute aortic syndrome that is disclosed with a rising frequency due to the development of new diagnostic methods. Different symptoms contribute to clinical misdiagnosis, while changeable locations and unpersuasive diameter can lead the radiologists to underestimate such changes. The outcome of PAU and IMH differs, and for the time being there are no data on prognostic factors. The diversity of symptoms and disease course is presented in four cases with different manifestations, treatment and outcome. Outline of Cases. Two patients with IMH were treated conservatively due to the process extensiveness and its morphology. One patient had a complete restitution, while the other had progression of the disease. Other two patients with PAU were treated by surgery (stent graft implantation) according to the morphology and diameter of the aorta. Conclusion. IMH and PAU should be suspected in patients with unclear clinical presentation (back and abdominal pains). Although outcome and complications of these diseases are well known, their incidence has not been fully studied. Endovascular treatment is less invasive and followed by a potentially lower rate of complications. However, usage of this method is justifiable only in patients with associated complications.

Keywords: intramural haematoma, penetrating aortic ulcer, unusual aortic dissection