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The

n e w e ng l a n d j o u r na l

of

m e dic i n e

Images in Clinical Medicine


Lindsey R. Baden, M.D., Editor

Vertebral-Body Erosion in Thoracic Aortic


Aneurysm
A

Joris Wansink, M.D.


Frank G.H. van der Kleij, M.D.,
Ph.D.
Scheper Hospital
Emmen, the Netherlands
j.wansink@gmail.com

74-year-old man presented with acute back pain but without


neurologic symptoms. The blood pressure was normal. He had a history of
hypertension, open repair of an aortic infrarenal aneurysm, and end-stage
renal failure that required hemodialysis. Computed tomography revealed a thoracic
aneurysm that measured 8.1 cm by 11.7 cm in the greatest dimensions on the
axial view and well-corticated erosions of thoracic vertebrae 10 and 11 (Panel A
shows the coronal view, Panel B the axial view, and Panel C the sagittal view; yellow arrows show the aneurysm, red arrows the erosion, and the blue arrow thoracic vertebra 11). Thoracic vertebral erosion, which is more often seen after aortic
graft surgery, is a rare complication of thoracic aortic aneurysm. The suggested
mechanism is repetitive mechanical pressure causing relative ischemia in the
bone, which leads to lysis and bone destruction. Differential considerations for a
retroperitoneal mass eroding vertebrae include tumor and infection. The preservation of disk spaces seen in this patient makes infection unlikely, and the presence
of a thin calcific rim surrounding the mass (Panels B and C, white arrows) is most
consistent with a large aortic aneurysm. Because of the patients poor general
health, no surgical repair was performed. With conservative treatment, the patient
lived another 3 years. He died after a short episode of recurrent back pain for
which palliative treatment was given.

DOI: 10.1056/NEJMicm1506911
Copyright 2016 Massachusetts Medical Society.

e10

n engl j med 374;9

nejm.org

March 3, 2016

The New England Journal of Medicine


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