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Case Reports
. 2018 Feb 20;2018(2):rjy020.
doi: 10.1093/jscr/rjy020. eCollection 2018 Feb.

A surgical case of inflammatory abdominal aortic aneurysm that responded remarkably to preoperative steroid therapy

Makoto Iijima  1 , Ryota Azuma  1 , Tetsuya Hieda  1 , Yutaka Makino  1
Affiliations
Case Reports

A surgical case of inflammatory abdominal aortic aneurysm that responded remarkably to preoperative steroid therapy

Makoto Iijima et al. J Surg Case Rep. .

Abstract

We describe the surgical management of a 58-year-old man with inflammatory abdominal aortic aneurysm (IAAA) following treatment with preoperative steroids. The patient was transferred to our institution for abdominal pain and fever. Contrast-enhanced computed tomography showed juxtarenal abdominal aortic aneurysm surrounded by dense perianeurysmal fibrous tissue. Under a diagnosis of IAAA, steroid therapy with prednisolone was initiated to control the perianeurysmal inflammation. It continued for 3 weeks with a decreasing dose schedule, with remarkable decrease in the soft tissue mass. The patient underwent elective surgery 21 days after commencing steroid therapy. During surgery, adjacent organs were adherent to the aneurysmal wall, but fibrotic change to the retroperitoneum was very limited. He recovered uneventfully, and was discharged on postoperative Day 10. Therefore, it can be concluded that preoperative steroid therapy could minimize the operative risk for IAAAs, and improve surgical outcome.

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Figures

Figure 1:
Figure 1:
(A) Contrast-enhanced computed tomography scan at the time of admission showing a 50-mm juxtarenal abdominal aortic aneurysm surrounded by dense fibrous tissue (white arrows). (B and C) The perianeurysmal fibrous tissue became smaller along with the course of steroid therapy, 7 and 14 days after the initiation of steroid therapy, respectively. (D) Postoperative computed tomography scan showing a patent graft with near disappearance of the fibrous tissue.
Figure 2:
Figure 2:
Intraoperative image showing that a small range of the aneurysmal wall was severely thickened (white arrows) but the fibrotic change of the retroperitoneum was limited.
Figure 3:
Figure 3:
Light microgram of the hematoxylin and eosin-stained aortic wall revealing the collapsed structure of the tunica intima (single asterisk), and the marked thickening in the tunica adventitia due to infiltration by inflammatory cells (black arrows) accompanied with fibrous proliferation.
See this image and copyright information in PMC

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