Mycotic thoracic-abdominal aortic aneurysm secondary to spondylodiscitis
Presentation
The patient is experiencing chronic back pain and is currently undergoing treatment for spinal tuberculosis.
Patient Data
MRI of the spine shows signs of T10-T11 and L4-L5 spondylodiscitis, manifested by fluid content in the disc spaces with large erosions of the end plates and multilocular paravertebral abscess collections, mainly at T10-T11. There is also aneurysmatic dilatation of the distal thoracic aorta and suprarenal part of the abdominal aorta with partial thrombosis of the lumen of the aneurysm. The aortic aneurysm is in contact with the paravertebral abscess at T10-T11 disc level with a focal defect of the wall of the aneurysm at 5 o’clock. Contrast enhancement of the aortic wall is seen. Sagittal T2 images of the spine show multiple small pockets of abscess surrounding the aneurysm. The axial T1 contrast-enhanced images show enhanced wall of the aneurysm.
Case Discussion
The most likely diagnosis in this case is a mycotic aneurysm secondary to spondylodiscitis. Tuberculosis is the presumed infective agent because it is endemic in the patient's region but this was not proven microbiologically. Unusually for this case, this is a fusiform aneurysm, which may indicate that this is an infection of a pre-existing aneurysm (i.e. an aortitis) rather than a de novo mycotic aneurysm, which tend to be saccular. Additionally, the location at the thoraco-abdominal aorta is rare with most infections of pre-existing aneurysms being in the infrarenal segment of the abdominal aorta. Unfortunately, no further follow-up is available as the patient died shortly after the scan.
Acknowledgment: Nusaibah Ghaleb Yousef Alnahari
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