Nontraumatic Rupture of Lumbar Artery Causing an Intravertebral Body Pseudoaneurysm: Treatment by Transcatheter Embolization

Abstract

We report a case of nontraumatic rupture of the lumbar artery that led to a pseudoaneurysm in the vertebral body and massive retroperitoneal to retropleural hematoma. The pseudoaneurysm was successfully treated by endovascular embolization. To our knowledge, idiopathic rupture of the lumbar artery has been reported in a limited number of cases and pseudoaneurysm formation in the vertebral body has not been presented in the literature. The etiology of hemorrhage has been discussed based on CT, MRI, and three-dimensional rotational angiography.

Lumbar artery pseudoaneurysm as a late complication of osteomyelitis with vertebral body destruction

“…11 Lumbar artery lesions, given their propensity to rupture, appear to be a potentially serious collateral damage of which clinicians should be aware. 12,13 To the best of our knowledge, two cases have been previously published with no such offending factors, 12,14 of which one of them suggested vertebral bodies fishbone-like deformity related to osteoporosis. 14 In our case, there were very advanced destructions of L3 and L4 vertebral bodies (Figs 1, B and C, and 3, D).…”

“…12,13 To the best of our knowledge, two cases have been previously published with no such offending factors, 12,14 of which one of them suggested vertebral bodies fishbone-like deformity related to osteoporosis. 14 In our case, there were very advanced destructions of L3 and L4 vertebral bodies (Figs 1, B and C, and 3, D). Indeed, vertebral osteomyelitis is known for causing serious vertebral alteration.…”

“…We chose percutaneous selective arterial embolization, as it has emerged as the gold standard treatment owing to its minimally invasive nature and its efficacy. 5,8,9,11,14,16 Small particle use, potentially migrating very distally into artery outflow, has been incriminated in the excessively rare neurologic complications. One single case, to our knowledge, of spinal ischemia after lumbar artery embolization was reported.…”

Treatment of Spontaneous Lumbar Artery Pseudoaneurysm by Computed Tomography—Guided Thrombin Injection

“…[4][5][6][7][8][9] Spontaneous lumbar artery pseudoaneurysm has been described only twice in the literature. 10,11 In 3 other cases, the pathogenesis of the pseudoaneurysm formation remained unknown, although the hypothesis for possible iatrogenic lumbar artery injury was secondary to forceful retraction during previous abdominal operations. 2,3,12 The pathogenesis of the pseudoaneurysm formation is unknown in this case.…”

A Case with Rapid Progression of Anemia Due to an Intravertebral Body Pseudoaneurysm with a 3-Column Osteoporotic Vertebral Fracture from Ankylosing Spinal Disorder

“…These may also trigger other disturbances, including gastroesophageal reflux disease, which can significantly deteriorate the patients' daily living activities. Intravertebral aneurysm is very rare, with just a single case report 5) , defined as a nontraumatic rupture of the lumbar artery with a pseu-doaneurysm in the vertebral body with a massive retroperitoneal hematoma treated by endovascular embolization. The current case indicates that the 3-column L3 vertebral body fracture caused the intervertebral cleft with spinal instability.…”