Chronic, contained rupture of aortic aneurysms associated with vertebral erosion

Chronic, contained rupture of aortic aneurysms is an important subset of ruptured aneurysms. Their presentation is unusual, and the diagnosis may be delayed. The associated vertebral erosion may contribute to the difficulty in diagnosis. The courses of three patients with chronic, contained rupture of an aortic aneurysm associated with vertebral erosion are presented. In each case the presentation was unusual and the initial diagnosis delayed. Computed tomography demonstrated the contained rupture and vertebral erosion in all cases. Microorganisms were cultured from all three aneurysms. Repair was successful in all cases. Contained rupture of an aortic aneurysm should be considered in older patients with unexplained back pain, and the possibility of this condition should not be ignored when there is a history of arthritic back pain or a radiograph suggestive of degenerative disease. Urgent surgical repair is indicated to prevent lethal, uncontrolled hemorrhage.