ABSTRACT

Erosion of a vertebral body related to continuous pulsatile compression by an abdominal aortic aneurysm is quite rare. Behçet’s disease is found to be coexistent in most of the cases. A 70 year old male patient was admitted to our clinic with complaints of intense lower back pain that had been persistent for a few weeks. He recalled that a duller back pain had been present for about 6 months previously. He had no history of Behçet’s disease, and no oral or genital ulcers was found to be present. On physical examination, a pulsatile abdominal mass was found. Serological and pathological tests were negative for Behçet’s Disease and all further laboratory work-up was found to be normal. Further examination with computed tomography angiography revealed a ruptured abdominal aortic aneurysm, beginning 1 cm inferior to the renal arteries and extending down to involve both common iliac arteries. The maximum diameter of the aneurysm was 5.5 cm and a posterior rupture was detected just anterior to the third lumbar vertebra with concomitant erosion of the vertebral body. The patient underwent an emergency operation for repair of the ruptured aneurysm. When the aneurysm was dissected, a rupture causing a 3x4 cm defect on the posterior wall of the abdominal aorta was found. Severe erosion of the lumbar vertebral body was visible just posterior to this ruptured section of the aneurysm. Aorta bifemoral bypass grafting was performed. The patient recovered without any incidents and was discharged on the sixth postoperative day. Despite the rarity of vertebral erosion in abdominal aortic aneurysms, non-coexistence of Behçet’s Disease is much rarer, as in our case. It may be caused by continuous, pulsatile pressure of the chronic abdominal aneurysmal sac on the osteoporotic, loosened bone tissue in these patients. If lack of the anterior column support could result in future instability, reconstruction and various operations on the vertebra may be necessary in these patients. Under emergency operation for the rupture of the abdominal aorta, no further emergency intervention was found to be necessary for the vertebral column in our patient. Following his discharge, elective operation was planned for the possible danger of instability of the anterior column in the future due to the resultant defect in the lumbar vertebral body. Although mostly detected in Behçet’s Disease, vertebral erosion could be present also in the aged patient group. In the differential diagnosis of lower back pain, abdominal aortic aneurysm and the rarer condition of concomitant vertebral erosion should be kept in mind in these patients. (JAREM 2011; 1: 72-3)

Keywords: Abdominal aorta, aneurysm, vertebral erosion