Presentation
Abdominal discomfort, pulsatile mass.
Patient Data
Large, lobulated infrarenal abdominal aortic aneurysm associated with low-attenuation retroperitoneal adenopathy and soft tissue thickening. Note soft tissue thickening extending around most of the aneurysm including the IMA. Right common iliac is occluded proximally.
Suspected spread along the anterior longitudinal ligament of the lower lumbar spine with large, complex right iliopsoas abscess.
Retroperitoneal soft tissue thickening, adenopathy, and right iliopsoas abscess have decreased following treatment. Abdominal aortic aneurysm is smaller with some residual irregularity/lobulation. Right common iliac remains nearly occluded with thready iliac flow.
Case Discussion
Biopsy-proven case of tuberculous mycotic abdominal aortic aneurysm in a young male. The relatively characteristic appearance of low-attenuation retroperitoneal adenopathy and intramuscular abscesses can help to suggest TB as the cause. The highly irregular appearance of aneurysm and surrounding soft tissue thickening indicate an inflammatory or infectious/mycotic etiology.
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