Inflammatory Abdominal Aneurysm - case report

Inflammatory abdominal aneurysm (IAA) is a form of aneurysm of the abdominal aorta which occurs very rarely and is hard to diagnose. A pathogenesis of IAA had not been clarified yet. Its rare occurrence and atypical image and clinical course make diagnosing IAA difficult. The authors present a case of 59-year old man with a year-long intra-abdominal and lumbar pains. USG examination showed a aneurysmatic widening of abdominal aorta up to 7 cm within the distance of 12 cm located below the renal arteries reaching the bifurcation of the aorta and including the initial fragments of iliac arteries. The images obtained were considered ambiguous. A possibility of dissecting aneurysm or inflammatory aneurysm were assumed. The CT of abdominal cavity and angio CT of abdominal aorta were performed. The received imaged were reconstructed with MPR and MIP. The wall of abdominal aorta and iliac arteries were thickened and enhanced after intravenous administration of contrast medium The symptoms of morbid changes on the duodenum wall and the first loop of small intestine, wall of vena cava inferior and left renal vein were visible. On the basis of the imaged symptoms a presence of inflammatory abdominal aneurysm was diagnosed. After aneurysmotomy, a bifurcated prosthesis was implanted. The post-operative treatment was without complications. US and CT were of greatest importance in IAA diagnosis. The authors estimate sensitivity of US as 60% and CT as 90%. Diagnostic capacity of CT is increased by angio CT and MPR and MIP image reconstructions. (author)