Ruptured arterial aneurysm in Wegener's granulomatosis: a case report

Abstract

Background: Aneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener's granulomatosis. Urgent diagnosis and therapy is very important because a ruptured aneurysm could be life threatening.

Case presentation: We, therefore, present the case of a 63-year-old Greek man who was diagnosed with granulomatosis with polyangiitis and retroperitoneal hematoma due to ruptured aneurysm in renal artery and upper pancreaticoduodenal artery. His clinical course was complicated by acute renal failure and acute respiratory failure due to alveolar hemorrhage. Emergency coil embolization was performed. Postembolization recovery was uneventful; no bleeding occurred. The patient underwent mechanical ventilation and continuous veno-venous hemofiltration and received combined immunosuppression and supportive therapy, but eventually died 30 days after admission to hospital from severe septic shock and multiple organ failure.

Conclusion: Endovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Early diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice.

Keywords: Aneurysm; Granulomatosis with polyangiitis; Immunosuppression therapy.

Fig. 1.

a CXR of the patient on admission showing infiltrative shadows in both lungs, especially in the left upper lobe. b Chest CT scan showing multiple intraparenchymal cavitated nodules in the left lung. c Abdominal CT scan showing a large retroperitoneal hematoma (arrow) and multiple aneurysms of the renal, hepatic, and pancreaticoduodenal arteries

Fig. 2.

Digital subtraction angiograms (DSAs, A arterial, B parenchymal phase) showing three pseudoaneurysms (arrows) of the pancreaticoduodenal arteries. DSA postembolization (C), with microcoils (arrows) and Gelfoam shows obliteration of the pseudoaneurysms