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radiological evidence of vertebral spondylodiscitis and a psoas collection that was presumed to be secondary to an infective process. These radiological findings were subsequently found to be due to a contained AAA rupture with no signs of sepsis intra-operatively.Fortunately, the delay in diagnosis did not alter the long-term outcome and the patient recovered well after appropriate surgical management. Case ReportWe report a case of a 63-year-old Caucasian male who is a chronic smoker, hypertensive, and dyslipidemic. He was presented with a 4-month history of low back pain and a 1-year history of limiting bilateral intermittent claudication. On examination, he had a pulsatile expansile abdominal mass with absent femoral and distal pulses. The anklebrachial index was 0.61 on the right and 0.46 on the left with no distal tissue loss. The rest of the examination was otherwise unremarkable with good cardiac and respiratory status. Further lab workup including a complete blood count, renal function, liver function, coagulation profile, and erythrocyte sedimentation rate (ESR) were normal except for an elevated C-reactive protein (CRP) of 26.The initial CT aortogram showed a 4 cm infra-renal AAA (Fig. 1). Visualization of the common iliac arteries revealed tight stenosis and focal occlusion on the right and left side respectively. In addition, a right-sided 5 cm × 2.8 cm psoas muscle collection was evident along with erosion of the L4 vertebrae (Fig. 2). A lumbar spine MRI confirmed this collection and showed evidence of spondylodiscitis at L4-L5 manifested by erosive vertebral changes.Our provisional diagnosis was therefore spondylodiscitis at L4-L5 complicated by vertebral erosion and a psoas abscess. Although it was suspected, whether or not the aorta was involved in the infective process or even ruptured with a contained hematoma was a question yet to be answered.With these findings in mind, the patient was immediately referred to our infectious disease and neurosurgery service that opted to treat the spine infection non-operatively and obtain a CT-guided aspirate of the psoas collection.A 63-year-old Caucasian male presented with a 4-month history of low back pain associated with bilateral intermittent claudication. A contrast enhanced CT scan demonstrated a 4 cm abdominal aortic aneurysm (AAA), along with severe bilateral aorto-iliac disease, a right psoas collection, and extensive vertebral erosion. An MRI of the lumbar spine suggested spondylodiscitis at L4-L5. After an unsuccessful and prolonged course of antibiotics, a decision was ultimately made to repair the aneurysm and bypass the aorto-iliac disease. Intra-operatively, a chronic contained rupture (CCR) involving the posterior aortic wall was encountered and repaired with an aorto-bifemoral bypass graft.

Highlights Idiopathic true ulnar artery aneurysms are rare. Diagnosis of idiopathic ulnar artery aneurysms is by thorough history-taking, examination, and other imaging modalities. Treatment of idiopathic ulnar artery aneurysm depends on its location and associated symptoms.

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