Name : Morteza, Hamidreza
Family : Sanei Taheri, Haghighatkhah
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Resident : Parham Pashangpour, Mohsen Zakavati
Gender : Male
Age : 89
A 89 years old man with three weeks history of paraparalysis (2/5 Force), this patient was admitted in neurosurgery ward and was reffered to radiology department for CT guided biopsy of paravertebral mass.
On MR imaging there is a high signal mass lesion in T1 and T2 sequences with a signal compatible with blood, is seen that measured 68x56mm anterior to T9-T11 vertebral body with myelopathy and destruction of these vertebral bodies. Contrast-enhanced CT reveals an incidentally found aortic aneurysm. Intraluminal thrombosis makes irregular border with the patent lumen. CT without intravenous administration of contrast agent shows impending rupture in aortic aneurysm associated with hyper-attenuating crescent sign, in which the attenuation of intraluminal thrombosis of the aneurysm is more than that of the patent lumen. Also attenuation of intraluminal thrombosis of aneurysm more than psoas muscle in enhanced computed tomography (CT), shows impending rupture in aortic aneurysm.
malignant peripheral nerve sheath tumour
descending aortic aneurysm
lymphadenopathy or lymphoma
foregut duplication cysts:
oesophageal duplication cyst
Severe erosion of vertebral body because of an aortic aneurysm.
Discussion (Related Text)
Erosion of a vertebral body because of an thoracic aortic aneurysm is a rare condition. Vertebral erosion may be observed secondary to aortic aneurysm that develops because of inflammation, infection [1,2], and pathologies such as Behcet’s disease and syphilitic aortitis. Collapse and lytic lesions of the vertebrae are generally associated with fracture, tumor, osteoporosis, spondylodiscitis, or spondylitis. In our case, chronic thoracic aortic aneurysm caused vertebral erosion and may mimic tumor or infection. This is a very rare condition that is detected in patients admitted to the hospital with a complaint of paraparalysis and generally diagnosed coincidentally during radiological examination. There are only a few case reports published on chronic aortic rupture causing vertebral erosion [3,4]. Almost all previous reports are about vertebral destruction caused by a pseudoaneurysm that develops after graft operations. The patient reported in this study manifested vertebral erosions secondary to a primary aortic aneurysm. These erosions developed as a result of a passive process. Aortic aneurysm may cause pain according to the degree of the destruction or neurological deficit caused by the pressure on neural elements . In our case, neurological evaluation revealed a three weeks history of paraparalysis.
-Intraluminal thrombosis: Intraluminal thrombosis frequently occurs in aortic aneurysm and may be definitely diagnosed based on its presence along the inner aspect of intimal calcification as well as its irregular border with the patent lumen. In contrast to conventional angiography, CTA is able to detect the presence and also the extent of intraluminal thrombus.
-Impending rupture: Interestingly, the growth rate of even small aortic aneurysm in sequential studies is correlated with increased likelihood of aneurismal rupture. Therefore, periodic radiologic surveillance is advised for all aortic aneurysms. When the diameter of Aortic aneurysm increases, the thrombus-to-patent lumen ratio of aneurysm will decrease. Thus, decreased thrombus-to-patent lumen ratio is another sign of impending rupture. Another helpful radiological finding, in favor of impending rupture is hyperattenuating crescent sign which reflects hemorrhage in the mural thrombosis or in the aneurysm wall. This sign, if present, appears as an intramural area with attenuation of more than patent luminal region in unenhanced computed tomography (CT) or more than that of psoas muscle in contrast-enhanced CT. Extravasation of contrast media into mural thrombosis of aortic aneurysm, in the absence of frank hemorrhage, is also considered another sign of impending rupture and represents dissection of blood from patent lumen into luminal thrombosis which has not disrupted the aneurysm wall yet.
-Contained rupture: Previous rupture into a confined anatomic compartment should be suspected in patients with known history of aortic aneurysm, previous episodes of pa
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