Iliac artery pseudoaneurysm presenting as a paravertebral collection: a potentially fatal mimic

Abstract

Pseudoaneurysms of the iliac arteries are extremely rare and can complicate trauma, surgical or interventional procedures. We report a case of pseudoaneurysm arising from the common iliac artery in a 37-year-old man which presented as a paravertebral collection. As the MRI appearance mimicked spondylodiscitis, a CT guided biopsy was requested. However, the presence of a signal void centre guided the radiologist to the correct diagnosis, which was later confirmed on contrast-enhanced CT. Following unsuccessful treatment by percutaneous thrombin injection, open surgery was performed which revealed a leaking aneurysm associated with a huge retroperitoneal haematoma. We present this case to highlight the importance of considering vascular lesions as a differential diagnosis in patients presenting with a mass or pressure symptoms in different parts of the body. Misdiagnosing such lesions as soft tissue tumours or abscesses may result in serious consequences.

Same Clinical Reality of Spontaneous Rupture of the Common Iliac Artery with Pseudoaneurysm Formation—Comparison of Two Therapeutical Solutions, Endovascular Stent-Graft and Open Surgical Correction, for Two Cases and Review of the Literature

“…A pseudoaneurysm of the common iliac artery is an even more rare finding [ 29 ]. Causes of such an entity may include infection, blunt or penetrating trauma, vasculitis, neurofibromatosis, connective tissue disorders, being iatrogenic after endovascular catheterization, or after surgery and erosion from a malignant tumor [ 30 , 31 ]. They may present as abdominal pain with a palpable mass.…”

“…We also found some cases of iatrogenic cause. Taif et al [ 31 ] reported the case of a right common iliac artery pseudoaneurysm 20 years after bladder surgery treated by open aneurysmectomy and iliofemoral bypass. Doleman et al [ 45 ] presented a case of right external iliac artery pseudoaneurysm following balloon angioplasty in a patient with neurofibromatosis type 1 and bilateral pheochromocytoma managed using thrombin injection at the site of the pseudoaneurysm [ 45 ].…”

Embolization of pulmonary and systemic mycotic pseudoaneurysms in a pediatric patient

“…However, pseudoaneurysms can also be identified on venous phase imaging and diagnostic radiologists should be aware of this potential complication of systemic bacterial infection. PSAs may also mimic infectious fluid collections, which can be dangerous as drainage may result in rupture [ 6 , 7 ]. Therefore, both interventional and diagnostic radiologists should be aware of this condition prior to any percutaneous intervention.…”