Aortic aneurysm with spinal destruction

Case contributed by Dr Ian Bickle

Presentation

Patient presented with acute on chronic lower back pain.

Patient Data

Age: 70 years
Gender: Male

Large infra-renal abdominal aortic aneurysm, with variable signal within, in keeping with thrombus.  This extends nearly to the aortic bifurcation.

Extensive destruction of the anterior aspect of the lumbar vertebra.

No para-spinal collection.

Gigantic infra-renal abdominal aortic aneurysm, with a large volume of contained thrombus.  This displaces the kidneys laterally.

Dissection flap distal to the aneurysm sac.

Extensive bone scalloping and destruction of multiple lumbar vertebra, with bits of transverse process 'floating' in the aneurysm thrombus.

Case Discussion

This is the largest abdominal aortic aneurysm I have ever seen and with the most amazing bony destruction, especially in view of the aneurysm being non-inflammatory.

Quite breathtaking that the patient presented to an orthopedic ward and received an inpatient MRI lumbar spine to look for disc disease.

The patient underwent successful surgery, albeit the dissection flap extended and ruptured 'on table'.

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Case information

rID: 42301
Case created: 15th Jan 2016
Last edited: 21st Apr 2017
Inclusion in quiz mode: Included

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