Chronic Contained Rupture of an Abdominal Aortic Aneurysm: From Diagnosis to Endovascular Resolution

Abstract

A male patient, 69 years old, presented with fever, leucocytosis, and persistent low back pain; he also had an abdominal aortic aneurysm (AAA), as previously diagnosed by Doppler UltraSound (US), and was admitted to our hospital. On multislice computed tomography (msCT), a large abdominal mass having no definite border and involving the aorta and both of the psoas muscles was seen. This mass involved the forth-lumbar vertebra with lysis, thus simulating AAA rupture into a paraspinal collection; it was initially considered a paraspinal abscess. After magnetic resonance imaging examination and culture of the fluid aspirated from the mass, no infective organisms were found; therefore, a diagnosisof chronically contained AAA rupture was made, and an aortic endoprosthesis was subsequently implanted. The patient was discharged with decreased lumbar pain. At 12-month follow-up, no evidence of leakage was observed. To our knowledge, this is the first case of endoprosthesis implantation in a patient, who was a poor candidate for surgical intervention due to renal failure, leucocytosis and high fever, having a chronically contained AAA ruptured simulatingspodilodiscitis abscess. Appropriate diagnosis and therapy resolved potentially crippling pathology and avoided surgical graftrelated complications.

Ruptured abdominal aortic aneurysm: a surgical emergency with many clinical presentations

“…Approximately 4% of ruptured AAA are contained ruptures (fig 2). 26 They are also known as “sealed” or “spontaneously healed” aneurysms 27…”

Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a case report

“…The CT study, mainly using multiplanar reconstruction with 3D volume rendering, provides essential information for the subsequent therapeutic surgical planning [7,8]. The CMR examination allows evaluation for the presence of blood or thrombotic material in the pseudoaneurysm, as well as its size and relations, and to establish its blood nature, comparing the CE intensity with that of the adjacent arteries [9,10].…”

Surviving an abdominal aortic aneurysm type II endoleak rupture without surgical intervention

“…These patients can survive for a number of weeks without surgery. 11 Endoleak has been noted to be the Achilles heel of EVAR. Type II endoleaks have been particularly controversial with indications and methods of treatmentlacking consensus.…”