RUPTURED ABDOMINAL AORTIC ANEURYSM AND DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS

Introduction. Chronic rupture of an abdominal aortic aneurysm (AAA) is a rare presenting symptom of AAA. However, even fewer cases of chronic rupture of an AAA associated with vertebral hyperostosis have been reported in the literature. We give details of a case of chronic rupture of an AAA and diffuse idiopathic skeletal hyperostosis and describe their possible relation. Case report. We describe the case of an 84-year-old male who visited the emergency department because of a 20-day history of symptoms of muscle weakness accompanied by a high temperature, anaemia and normal blood pressure. A 6-centimetre pulsatile mass that was not painful when palpated was found in the umbilical region. A lateral X-ray of the spine revealed prominent osteophytes on the anterior side of the L3-L5 bodies; these findings suggested the existence of diffuse idiopathic skeletal hyperostosis. A computerised axial tomography scan showed the presence of an infrarenal chronic rupture of an AAA with a maximum diameter of 5 cm, which extended as far as the iliac bifurcation, with contained aortic rupture in the retroperitoneum and in both psoas compartments. During the preoperative study the patient suffered haemodynamic failure. Emergency surgery was performed and on opening the aneurysm no posterior aortic wall was found; the rupture was being contained by the lumbar vertebral bodies. The patient was discharged from hospital with no further incidences and in later check-ups no postoperative complications were observed. Conclusions. This case suggests that, in patients with AAA and evident vertebral hyperostosis, the diameter of the AAA is a risk factor for rupture that is less important than in patients without hyperostosis; earlier treatment should be considered in these cases.