Tuberculous mycotic abdominal aortic aneurysm

Case contributed by Dr Michael P Hartung

Presentation

Abdominal discomfort, pulsatile mass.

Patient Data

Age: 30 years
Gender: Male
CT

Presentation

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. 

CT

After surgical repair and short term treatment

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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Case information

rID: 72092
Published: 7th Nov 2019
Last edited: 11th Nov 2019
System: Vascular
Inclusion in quiz mode: Included
Institution: Tenwek Hospital

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