Emphysematous aortitis complicated by a rapidly evolving pseudoaneurysm of the abdominal aorta, a life-threatening emergency: Case report and literature review

Abstract

Emphysematous aortitis is a rare but serious clinical form of infectious aortitis that can lead to potentially fatal complications, in particular pseudoaneurysms of the aorta that rapidly progress to rupture. This article describes the case of a 61-year-old man who presented with severe abdominal pain of 10 days duration associated with a hypertensive crisis. Imaging revealed emphysematous aortitis complicated by an abdominal aortic pseudoaneurysm measuring 14 × 11 mm surrounded by periaortic inflammation and intramural gas. Despite early probabilistic antibiotic therapy, angio-CT surveillance revealed rapid growth of the pseudoaneurysm to 28 × 24 mm within 48 hours. Emergency surgical treatment with an aortic allograft was performed, and postoperative cultures identified Salmonella species as the pathogen. This case highlights the importance of imaging, particularly angioscan, in establishing the diagnosis, assessing the severity of this disease and the importance of prompt surgery in the management of this highly aggressive condition. A review of similar cases in the literature is included to contextualize this rare clinical entity.