Ruptured isolated external iliac artery true aneurysm associated with cystic medial necrosis: Report of a case

Abstract

We report a case of a ruptured isolated true external iliac artery aneurysm (EIAA). A 78-year-old woman was admitted to our institution in a shock state after the sudden onset of severe pain in the right hypogastric region. A pulsating mass was found in her right lower abdomen. Computed tomography (CT) with contrast medium showed an isolated EIAA, 40 mm in diameter, with a massive retroperitoneal hematoma. She underwent emergency resection of the aneurysm and reconstruction of the affected artery, without any complications. Histological examination confirmed a true aneurysm caused by cystic medial necrosis (CMN). She had no ocular, cardiac, or orthopedic abnormalities. We review the literature on isolated true aneurysms of the external iliac artery, which are extremely rare, and discuss their clinical manifestations.

A surprising diagnosis in a young patient with intermittent claudication: Symptomatic isolated external iliac artery aneurysm associated with cystic media necrosis

“…Crivello et al, 15 who first described the case of the isolated EIA aneurysm in association with CMN, reported a higher operative risk owing to the friability of the artery wall caused by the media degeneration. In 2009, Kato et al 16 reported their experiences in the treatment of an EIA aneurysm, but they could not conform the findings of Crivello et al. Similar to the experience of Kato et al, we also did not find fragile vessel walls in our bilateral open aneurysm repair.…”

Spontaneous rupture of abdominal aorta — an unusual manifestation of an idiopathic cystic medial necrosis (Gsell-Erdheim syndrome) and literature overview

“…The most common manifestation of the syndrome is aortic dissection, however other locations of the disease were also described [4][5][6][7][8][9][10]. To our knowledge, non-dilated abdominal aortic rupture such as we have observed in a patient treated at our facility was never previously reported and related to the idiopathic CMN.…”

“…As the knowledge of the distinct microscopic changes in CMN grew, it became apparent that it might involve different parts of vascular system. Ascending aortic, Valsalva sinus, coronary, iliac and visceral artery aneurysms were all described as manifestations site of CMN [4][5][6][7][8][9][10].…”

Isolated external iliac artery aneurysm: a rare case presentation of IgG4-related disease

“…1 They have been described in patients with ages ranging from 27 to 78 years. 2,3 Although most of the reported cases were unilateral, bilateral isolated EIAAs have also been reported. 4 The presentation of isolated EIAA can vary, ranging from asymptomatic to hemorrhagic shock in an emergency.…”