Uraemia Due to Aneurysm of the Abdominal Aorta

Abstract

THE specimen here described was found at autopsy in a woman of fifty-two who had been admitted with symptoms of uraemia. A detailed history was not available, and as the patient was stuporose on admission she was unable to co-operate in examination. A large fixed mass with an expansiie pulsation was found in the abdomen extending from the ensiform process down to a level just below the umbilicus. A catheter specimen of urine yielded a specific gravity of 1010 with some albuminuria. The clinical condition of the patient was that of advanced uraemia.The patient died the day following admission and the investigations were therefore incomplete. It was ascertained that she had been under treatment four years before at another hospital for pain in the back with a swelling in the abdomen. A diagnosis of aneurysm of the abdominal aorta had been made. At that time the Wassermann and Sigma reactions 140 were negative and the blood pressure -. 90An autopsy revealed a generalised atheroma of the arteries. The abdominal aorta presented an unruptured aneurysm extending from the level of the bifurcation up to the origin of the superior mesenteric artery. The wall of the aneurysm was very thick, in some parts nearly 1 inch. The vertebral bodies were deeply eroded. The kidneys were reduced to one-third the normal size and presented the macroscopic and microscopic appearances of chronic interstitial nephritis. The renal arteries ran obliquely upwards in the wall of the aneurysm and would admit only the finest probe. The ureters were intimately adherent to the wall of the aneurysm, considerably narrowed and flattened, but not completely obstructed.The renal atrophy would appear to be due to a combination of pressure on the renal arteries and ureters by the gradual increase in the size of the'aneurysm.The calices were not dilated.

Spontaneous regression of an abdominal aortic aneurysm in an immunocompromised patient

“…8 Furthermore, the patient developed a transient left hydronephrosis, which may have occurred due to retroperitoneal fibrosis versus ureteral obstruction by the inflammatory process, as described in the first reported cases of an inflammatory aneurysm. 9,10 If the aneurysm was inflammatory, the regression could have been secondary to progressive immunosuppression; however, the patient's CD4 was > 500/μl and he was not on any systemic immunosuppressive therapy. Therefore, it is unlikely that spontaneous regression would have occurred through this mechanism alone.…”

Abdominal Aortic Aneurysm with Perianeurysmal Fibrosis: Demonstration of Ureteric Obstruction by Computerized Tomography

“…DISCUSSION Ureteric obstruction associated with aortic aneurysms was first reported in 1935 (7). By 1982 there had been 56 cases reported of abdominal aortic or iliac arterial aneurysms with perianeurysmal fibrosis 12.…”

Ureteric Obstruction Due to Peri-Aneurysmal Fibrosis

“…The salient features of this and the 6 previously reported surgically treated cases are summarised in the Table. Labardini and Ratliff (1967) cite cases described at autopsy by Duchanoff (1934) and James (1935) as additional examples. In the former case a clinical diagnosis of hydronephrosis was not confirmed at autopsy, where a ruptured aneurysm was found.…”