An infected aneurysm of the vertebral artery following cervical pyogenic spondylitis: a case report and literature review

Abstract

Background: An important complication of pyogenic spondylitis is aneurysms in the adjacent arteries. There are reports of abdominal aortic or iliac aneurysms, but there are few reports describing infected aneurysms of the vertebral artery. Furthermore, there are no reports describing infected aneurysms of the vertebral arteries following cervical pyogenic spondylitis. We report a rare case of an infected aneurysm of the vertebral artery as a complication of cervical pyogenic spondylitis, which was successfully treated by endovascular treatment.

Case presentation: Cervical magnetic resonance imaging (MRI) of a 59-year-old man who complained of severe neck pain showed pyogenic spondylitis. Although he was treated extensively by antibiotic therapy, his neck pain did not improve. Follow-up MRI showed the presence of a cyst, which was initially considered an abscess, and therefore, treatment initially included guided tapping and suction under ultrasonography. However, under ultrasonographic examination an aneurysm was detected. The contrast-enhanced computed tomography (CT) scan showed an aneurysm of the vertebral artery. Following endovascular treatment (parent artery occlusion: PAO), the patient's neck pain disappeared completely.

Conclusion: Although there are several reports of infected aneurysms of the vertebral arteries, this is the first report describing an infected aneurysm of the vertebral artery as a result of cervical pyogenic spondylitis. Whenever a paraspinal cyst exist at the site of infection, we recommend that clinicians use not only X-ray, conventional CT, and MRI to examine the cyst, but ultrasonography and contrast-enhanced CT as well because of the possibility of an aneurysms in neighboring blood vessels. It is necessary to evaluate the morphology of the aneurysm to determine the treatment required.

Keywords: Case report; Infected aneurysm; Pyogenic spondylitis; Ultrasonographic examination; Vertebral artery.

Fig. 1

Magnetic resonance imaging performed on initial hospitalization at the referring hospital. a T2-weighted sagittal image revealed a high intensity lesion at the C6/C7 vertebral body (arrow), retropharyngeal space, and epidural space (arrowhead). The epidural lesion had compressed the dural sac from the ventral side b T2-weighted axial image at C6/7 revealed a high intensity lesion at the epidural space (arrowhead) that had compressed the dural sac from the ventral side

Fig. 2

Follow-up magnetic resonance imaging performed at referring hospital a T2 weighted parasagittal image at left side revealed a cyst at C6/C7 level (arrow) b T2-weighted axial image revealed a cyst at the retropharyngeal space, adjacent to the infected vertebral body (arrow). Dural sac compression by the epidural abscess remained (arrowhead)

Fig. 3

Ultrasonographic examination of the neck a Imaging with normal parameters showed pulsatile turbulence in the cyst (arrowhead) b Color Doppler imaging showed heterogeneous blood flow inside the cyst (arrowhead) c Color Doppler imaging showed the vertebral artery (arrowhead) linked to the cyst

Fig. 4

Contrast-enhanced computed tomography. a The arterial phase showed slight contrast-enhancement of the left vertebral artery (arrowhead) b The delayed phase showed a contrast-enhanced lesion in the cyst (arrowhead). The lesion was linked to the left vertebral artery

Fig. 5

X-rays obtained after endovascular treatment Both the anteroposterior (a) and mediolateral views (b) showed the coiled left vertebral artery (arrowhead)