An Eight-Year Natural History of Chronic Contained Rupture With Vertebral Erosion

Abstract

A 70-year-old man presented with right back pain and was diagnosed as having cholecystitis. Preoperative computed tomography scan incidentally revealed a thoracoabdominal aortic aneurysm (TAAA) measuring 35 mm in diameter and mild vertebral erosion (Fig 1, arrow). He was afebrile and normotensive. Laboratory data showed no abnormal parameters, including hemoglobin level, tumor markers, or any evidences of infection except for elevated C-reactive protein. He underwent cholecystectomy, and his right back pain was relieved. Because vertebral erosion was not significant and the size of TAAA did not meet the criteria for surgical intervention, he was followed up on an outpatient basis. However, another computed tomography scan showed progressive vertebral erosion and hematoma in the left psoas muscle without any significant increase in the aneurysm size (Fig 2A, initial scan; 2B, 2 years later; 2C, 5 years later; and 2D, 8 years later). Therefore, we diagnosed the patient as having chronic contained rupture of a TAAA with vertebral erosion, and open repair was performed. A punched-out defect was found at the posterior wall of the aneurysm, and the cavity of vertebral erosion was filled with an old hematoma. The patient is asymptomatic without neurologic deficits at 6 months after surgery.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)