Vertebral erosion due to chronic contained rupture of an abdominal aortic aneurysm.

Abstract

A 75 year-old man presented to an orthopedic clinic with chronic lower back pain that had gradually increased for 1 year. A computed tomography (CT) scan revealed destruction of the corpus of the L4 vertebra from a contained posterior rupture of an abdominal aortic aneurysm (AAA) with a 10-cm maximum diameter (A). His medical history included controlled hypertension, hyperlipidemia, and prior cigarette use. A vascular surgeon evaluated the patient, and a CT angiography confirmed an infrarenal AAA with contained retroperitoneal rupture (B). The AAA was easily palpable on examination, but had not been previously noticed. During open surgical repair, a chronic, organized hematoma was found within the destroyed vertebral corpus as well as the adjacent retroperitoneum. An infrarenal polyester tube graft (22 mm) interposition was performed (Cover). The patient had an uneventful postoperative course. The orthopedic surgeons did not recommend vertebra repair. The patient remains well 18 months after vascular surgery, without progression of the vertebral defect (C).