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Case Reports
. 2015 May-Jun;48(3):192-4.
doi: 10.1590/0100-3984.2014.0029.

Hybrid treatment of penetrating aortic ulcer

Juan Antonio Herrero Lara  1 , Daniela de Araújo Martins-Romêo  1 , Carlos Caparrós Escudero  1 , Rosa María Lepe Vázquez  2 , María Del Carmen Prieto Falcón  3 , Vinicius Bianchi Batista  3
Affiliations
Case Reports

Hybrid treatment of penetrating aortic ulcer

Juan Antonio Herrero Lara et al. Radiol Bras. 2015 May-Jun.

Abstract
in English, Portuguese

Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease.

A úlcera aórtica penetrante é uma entidade rara e de prognóstico desfavorável dentro da síndrome aórtica aguda. Mais raros ainda, na literatura, são os casos como o aqui relatado, localizado no arco aórtico, que começa com dor torácica e evolui com disfonia. O presente caso enfatiza o papel da tomografia computadorizada no diagnóstico da úlcera aórtica penetrante e na sua diferenciação de outras entidades dentro da síndrome aórtica aguda. Apresenta também um avanço terapêutico nessa doença, constituído por tratamento híbrido endovascular e cirúrgico.

Keywords: Aortic diseases; Atherosclerosis; Cardiovascular surgery; Computed tomography; Thoracic aorta.

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Figures

Figure 1
Figure 1
3D reconstruction, volume-rendered image. Digitform or collar button image deforming the expected contour of the aortic arc wall between the common carotid and left subclavian arteries, compatible with PAU.
Figure 2
Figure 2
Sagittal (A) and coronal obliques (B,C) maximum intensity projection reconstruction images. Surrounding hyperdensity with peripheral enhancement compatible with parietal hematoma (asterisks); sign of instability at the theoretical location of the left recurrent laryngeal nerve which explains the clinical signs of dysphonia.
Figure 3
Figure 3
Sagittal oblique (A) and axial (B) maximum intensity projection reconstruction images of other patient in whom a common and uncomplicated ulcer was incidentally diagnosed during the investigation of other non-related disease. A digitform image is identified deforming the proximal descending aorta contour. The surrounding hypodense image is compatible with thrombotic material and not a mural hematoma.
Figure 4
Figure 4
Post-treatment CT. 3D reconstruction, volume-rendered image. The supra-aortic trunks are preserved by means of debranching with a bifurcated Dacron tube graft (Dacron prosthesis – DP) from the ascending aorta to the brachiocephalic arterial trunk and left common carotid artery (LCCA), followed by endovascular (femoral approach) placement of a prosthesis in the aortic arch, with satisfactory evolution observed at threemonth follow-up. RSA, right subclavian artery; RCCA, right common carotid artery; RVA, right vertebral artery.
See this image and copyright information in PMC

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