doiSerbia

Vertebral erosion due to chronic rupture of aneurismatic abdominal aorta

Čolić Nikola (Clinical Center of Serbia, First Surgical Clinic, Center for Radiology and MRI, Department of Abdominal Radiology, Belgrade, Serbia)
Šaponjski Dušan (Clinical Center of Serbia, First Surgical Clinic, Center for Radiology and MRI, Department of Abdominal Radiology, Belgrade, Serbia)
Stojadinović Milica (Clinical Center of Serbia, First Surgical Clinic, Center for Radiology and MRI, Department of Abdominal Radiology, Belgrade, Serbia)
Jeremić Danilo (Banjica Institute for Orthopedic Surgery, Belgrade, Serbia)
Parapid Biljana (Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Mašulović Dragan (Clinical Center of Serbia, First Surgical Clinic, Center for Radiology and MRI, Department of Abdominal Radiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)

Introduction. Extremely rarely, the evolution of abdominal aortic aneurysm (AAA) includes the phase when extravasations of the blood from a ruptured aneurysm is contained by the surrounding tissue, referred to as chronic (contained) rupture of the AAA. Our aim was to call attention to this life-threatening condition, which is always challenging for diagnosis. Case outline. A 58-year-old man reported to the Emergency Center for significant abdominal pain. Ultrasound examination showed an infrarenal aneurysm of the abdominal aorta. A computed tomography scan of the thorax, abdomen, and pelvis with iodine contrast in arterial phase was performed. A free gas collection was observed between the liver and the anterior abdominal wall that is traced to a ruptured inflamed diverticulum on the transversal colon. Immediately distal to the branching sites of the renal arteries, the abdominal aorta extended forward and aneurismatically expanded. Posterior left, along the psoas muscle, a rupture of the aortic wall was seen, with an organized hematoma that accompanied the muscle. Between the hematoma and the aortic aneurysm, erosions of the anterior and lateral part of the vertebral bodies L2 and L3 were discovered. The patient underwent endovascular AAA repair (EVAR) and recovered well. Conclusion. Multidetector computed tomography angiography is a reliable, non-invasive, and necessary examination for localization and evaluation of the size of the AAA form, its chronic rupture, and complications such as vertebral body erosion.

Keywords: abdominal aorta aneurysm, chronic rupture, vertebral body erosion