Differential diagnosis of inguinal pain: isolated symptomatic dissections of the infrarenal aorta and iliac arteries

Introduction: Pelvic and inguinal pain are a rare manifestation of arterial disease. Methods: Description of four patients with acute or chronic pelvi c or inguinal pain due to symptomatic dissection of the infrarenal aorta an d/or iliac arteries. Results: In two cases the dissection was limited to th e left iliac artery with an entry at the beginning of the common iliac arte ry. The reentry was located in the distal external iliac or common femoral artery. In one patient additionally a infrarenal abdominal aortic aneurysm was found. In the other two patients the entry of the spontaneous dissectio n was in the position of the infrarenal aorta, with extension in one iliac artery. In two patients the diagnosis of Erdheim-Gsell media necrosis was h istologically confirmed. Conclusions: Spontaneous arterial dissection shoul d be considered in patients with pelvic or inguinal pain. Absence of thorac ic symptoms is possible if the entry of the dissection is distal, within th e infrarenal aorta or iliac arteries. Prompt diagnosis with duplex sonograp hy, CT, arteriography or MRA is indicated. The type of reconstruction depen ds on the extent of the dissection and the concomitant arterial disease.