Abstract
BackgroundChronic contained rupture is a subtype of an abdominal aortic aneurysm rupture. Its diagnosis is sometimes difficult due to lack of typical symptoms. We would like to report the challenge of diagnosing chronic contained rupture of abdominal aortic aneurysm with a retroperitoneal tumor.Case presentationA 60-year-old man reported perceived lower abdominal pain 7 months earlier that spontaneously remitted. A contrast-enhanced computed tomography (CT) indicated an abdominal aortic aneurysm and a mass lesion surrounding the abdominal aorta and iliac arteries. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed an increased accumulation of FDG in the margin of the lesion, indicating a retroperitoneal tumor. A CT-guided biopsy revealed only retroperitoneal fibrous tissue with chronic inflammation. We were thus unable to reach a definitive diagnosis. At 1 month after the initial examination, intermittent claudication was newly observed. A follow-up contrast-enhanced CT scan revealed abdominal aortic occlusion. Mass resection and bypass surgery were performed for diagnosis and treatment. Intraoperative and pathological findings led to the diagnosis of chronic contained rupture of an abdominal aortic aneurysm. The patient was discharged 19 days after surgery.ConclusionThe mass peripheral to the abdominal aorta should be considered the possibility not only of tumor but also of chronic contained rupture of an abdominal aortic aneurysm.
Highlights
Chronic contained rupture is a subtype of an abdominal aortic aneurysm rupture
On computed tomography (CT) scanning, we found an arterial occlusion from the infrarenal abdominal aorta to the bilateral common iliac arteries, the right external iliac artery, and the right internal iliac artery (Fig. 3)
It is characterized by low blood loss and stable hemodynamics, which are due to hemostasis by tissue peripheral to the retroperitoneum when the aortic aneurysm ruptures [4, 5]
Summary
Chronic contained rupture of an abdominal aortic aneurysm (CCR-AAA) is a well-known subtype of a AAA rupture. On CT scanning, we found an arterial occlusion from the infrarenal abdominal aorta to the bilateral common iliac arteries, the right external iliac artery, and the right internal iliac artery (Fig. 3) These findings indicated the potential progress of the tumor to the aorta. Biopsies of the mass and the lymph nodes peripheral to the sigmoid colon were obtained These biopsies showed only connective tissue with inflammation and fibrosis and did not yield any significant findings. On the basis of the intraoperative and pathologic findings, the patient was diagnosed with CCR-AAA with abdominal aortic occlusion. His intermittent claudication improved, and he was discharged on day 19 after surgery. Six months after the operation, the retroperitoneal mass disappeared on CT
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