Vertebral erosion resulting from a 'non-ruptured' abdominal aortic aneurysm: case report and literature review

The natural history of abdominal aortic aneurysms (AAAs) renders them clinically silent for much of their evolution. These aneurysms will inevitably expand with time and, although surveillance programmes exist, an acutely ruptured AAA is still a relatively common clinical scenario. The classical presentation is with rapid haemodynamic deterioration with accompanying severe abdominal or back pain. Less commonly, patients may present with a stable haemodynamic profile and vague symptomatology; they are usually found to have a chronic contained rupture with a defect in the vascular wall with co-existent pseudoaneurysm and retroperitoneal haematoma formation. We report a rare case of AAA with posterior wall defect and erosion into the vertebral body with no accompanying pseudoaneurysm or haematoma and discuss the clinical implications of such a presentation.