Dorsolumbar vertebral destruction revealing a suprarenal aortic pseudoaneurysm: Clinical and imaging challenges

Abdominal aortic pseudoaneurysms are rare but life-threatening, particularly when associated with vertebral erosion. Aortic pseudoaneurysm is one of the most important causes of death due to its high risk of rupture and associated mortality. We present the case of a 63-year-old hypertensive woman with severe epigastric pain radiating to the thoracolumbar spine. Imaging revealed a partially thrombosed suprarenal aortic pseudoaneurysm causing vertebral destruction and visceral compression. CT angiography and MRI demonstrated characteristic findings, including bony erosion and a "double-contour" sign, without active rupture. Urgent endovascular repair was prioritized due to high-risk features. This case highlights the diagnostic challenges, pathoanatomical mechanisms of vertebral erosion, and multidisciplinary management of this rare entity. Early recognition and intervention are critical to prevent catastrophic complications.