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Chronic contained rupture of an abdominal aortic aneurysm with vertebral erosion

Chih-Cheng Lai, MD^*, Che-Kim Tan, MD, Tung-Wei Chu, MD and Liang-Wen Ding, MD

*Department of Internal Medicine, Yi-Min Hospital, Taipei, Taiwan; Department of Intensive Care Medicine, Chi-Mei Medical Center, Yungkang, Taiwan; Section of Cardiovascular Surgery, Department of Surgery Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Critical Care Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan

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View larger version (97K): [in this window] [in a new window]   Computed tomography scan of the abdomen of a 67-year-old man with a 6-month history of low-back pain.

View larger version (71K): [in this window] [in a new window]   Figure 1: Computed tomography scan of the abdomen of a 67-year-old man showing erosion of the third lumbar vertebra (arrow).

View larger version (54K): [in this window] [in a new window]   Figure 2: Angiogram revealing an infrarenal abdominal aortic aneurysm 5.2 cm in diameter (arrow).

The chronic contained rupture of an abdominal aortic aneurysm is relatively rare (2.7% of operated infrarenal abdominal aortic aneurysms) and occurs when an aortic leak is contained by surrounding tissues.¹ Unlike an acute rupture, which has a mortality of about 60%, the symptoms of chronic contained rupture can be more subtle and include months of back pain. Other symptoms have been described, including obturator neuropathy, obstructive jaundice and groin hernia.² Symptoms are attributable to tissue compression or erosion and are most often found in the workup of back pain or an abdominal problem. A thorough clinical and radiological workup is required, and the radiological examination should involve a careful look at all structures surrounding the vertebral body. Computed tomography is the most reliable diagnostic test, and pathology can confirm an organized hematoma.³

Urgent intervention is necessary because the contained leaks are at high risk for free rupture, with the accompanying high mortality. If detected and repaired, the chronic contained rupture of an aortic aneurysm has a mortality similar to that associated with aortic aneurysms repaired electively. Surgical options include either open or endovascular procedures.

	Footnotes

 
This article has been peer reviewed.

Competing interests: None declared.

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1. Jones CS, Reilly MK, Dalsing MC, et al. Chronic contained rupture of abdominal aortic aneurysms. Arch Surg 1986;121:542-6.[Abstract/Free Full Text]
2. Saiki M, Urata Y, Katoh I, et al. Chronic contained rupture of an abdominal aortic aneurysm with vertebra erosion: report of a case. Ann Thorac Cardiovasc Surg 2006;12:300-2.[Medline]
3. Ando M, Igari T, Yokoyama H, et al. CT features of chronic contained rupture of an abdominal aortic aneurysm. Ann Thorac Cardiovasc Surg 2003;9:274-8.[Medline]

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This Article Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lai, C.-C. Articles by Ding, L.-W. Search for Related Content PubMed PubMed Citation Articles by Lai, C.-C., MD Articles by Ding, L.-W., MD Related Collections Other cardiovascular medicine Related Articles

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