Author(s)

E. Bassetti, F. Fraioli, F. Pediconi, C. Catalano

Patient

male, 63 year(s)

63 years old man with pain, tenderness, weight loss and elevated ESR. After a clinical and ultrasound suspect of AAA an MRA, Aortography and spiral CT were performed. MRA and spiral CT have shown an abdominal aneurism with the suspicion of inflammatory disease. Surgical and istological evaluation confirmed the radiological diagnosis.

Four months ago the patient presented symptoms of abdominal, back and flank pain with weight loss and elevation of the erythrocyte sedimentation rate (ESR). A clinical and ultrasound examination have diagnosticated an abdominal aortic aneurysm (AAA). For these reasons in our hospital an MRA, spiral CT and Aortography were performed. CT showed an abdominal aneurysm of the infrarenal aorta. The aneurismatic wall, with calcium deposits, was surrounded by a soft tissue mass which relatively displaced the aortic lumen. The diameter measured 8 cm with the residual lumen of 2,5 cm. An MRA was also performed that showed a series of concentric layers of both low and high signal intensity simmetrically surronding the aortic lumen. Aortography was of no diagnostic utility. With the radiological suspicion of inflammatory aneurism the patient was subjected to surgery. The operatory fragment was sent to the pathology department. The answer was inflammatory tissue in the contest of fibrous connettive mass.

Weight loss, pain, elevated ESR should always suggest an inflammatory abdominal aneurysm. Once suspected, the diagnosis in a patient with known aortic aneurysm, should be confirmed with either spiral CT and MRA that are the only techniques that allow to perform a correct diagnosis. Furthermore, these non invasive techniques provide an early diagnosis in a short time allowing to treat immediately the patient. The accuracy of these techniques allow to decide the most useful approach (clinical, surgical or interventional) for the patient.