Vertebral Body Erosion Due to a Chronic Contained Rupture of an Abdominal Aortic Aneurysm

Figure

CT angiography of the abdomen in the venous phase

A female patient in her 80s presented to the emergency department with progressive lumbar back pain. Abdominal ultrasound prompted suspicion of a large infrarenal abdominal aortic aneurysm (AAA). As part of the further evaluation, emergency CT angiography was performed, showing a predominantly thrombosed infrarenal AAA with a maximum axial diameter of 13.8 × 8.6 cm and a contained retroperitoneal rupture. There was a long segment of direct contact between the aneurysm and the lumbar vertebrae L3 and L4 (referred to as the draped aorta sign) with marked erosion of the anterior vertebral margins as a result of chronic mechanical pressure exerted by the AAA. The contour of the left psoas major muscle was markedly displaced, most likely due to rupture of the psoas fascia. Posteriorly, the aneurysm sac was in contact with the left L3 neural foramen. The AAA was surgically managed in the further course. In cases of contained rupture of an infrarenal AAA, retroperitoneal tamponade limits further bleeding. Vertebral body erosion is a rare sequela that occurs in approximately 5% of cases of chronically contained ruptured AAAs.

Janek Rebesky, PD Dr. med. Sebastian Zensen, Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, [e-mail]

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Rebesky J, Zensen S: Vertebral body erosion due to a chronic contained rupture of an abdominal aortic aneurysm. Dtsch Arztebl Int 2025; 122: 510a. DOI: 10.3238/arztebl.m2025.0115