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An 81 year old woman with hypertension and diabetes mellitus was admitted for evaluation of severe lumbago and a month long history of high fever of unknown origin. Laboratory investigations showed white blood cell count of 0.234 × 1012/l and a C-reactive protein concentration of 238 mg/l. Aortography (A) and three dimensional imaging reconstructed from abdominal spiral computed tomography (CT) (B) revealed a 60 mm pseudo-abdominal aortic aneurysm with leakage of contrast medium (contrast medium is in colour). Spiral CT images taken from sagittal and coronal angles also demonstrated the aortic aneurysm and leakage of contrast medium in two cavities.
The aneurysm was resected and a bypass graft of right axillar artery to both femoral arteries was used for reconstruction. The aneurysm was 60 × 70 mm in diameter with a rupture of 30 × 20 mm. The aneurysm was divided into two cavities, containing white thrombi caused by a pyemic abscess, and there were adhesions between the upper cavity of the aneurysm and the jejunum with a small penetration into the serosa. Histopathological examinations showed neutrophil infiltrations from the adventitia to the intima of the resected aneurysm, and Escherichia coli was detected by culture of the abscess. The postoperative course was uneventful.
Three dimensional images taken from various angles constitute a non-invasive and useful method to diagnose such serious infectious aortic aneurysms early and to examine the structures in relation to the aneurysm.