Abdominal Aortic Pseudo-Aneurysm, a Dreadful Complication of Caries Spine – A Case Report

Abstract

The thoracic spine is the most frequently involved region in carries spine, 60 percent; and in the thoracic spine, more than 70 percent occur in the midthoracic regions D8, 9, 10. The cauda equine and lumbosacral involvement frequency are less frequently involved. But the vascular complication it causes is a rare disease, with high mortality when it involves adjacent critical vascular structures like the abdominal aorta with complicating aneurysm and pseudoaneurysm. Evaluating a patient with a caries spine starts with a thorough history, physical examination findings, laboratory investigations like CBC, ESR, CRP, ICT TB, etc., complete radiological workup like X-rays, 3-D CT reconstruction of the whole spine, MRI whole spine with and without contrast. We presented a case of 21 years male who was suffering from caries spine, at D11 – D12; which had eroded his abdominal aorta secondary to bony spicules of carries. This erosion of the aorta had blood leak into psoas muscle, which was mimicking psoas abscess on preoperative CT scan spine, and MRI whole spine. During corrective surgery for his caries spine, unexpected torrential bleeding was encountered, when the left psoas muscle was given nick. Bleeding was stopped with packs and with the help of a cardiac surgeon. Postoperatively the patient was kept in ICU, but unfortunately on the 8^th post-surgery patient succumbs to his illness. In our case, psoas muscle pseudoaneurysm was missed radiologically in both MRI and CT spine preoperatively. Angiography with endovascular aortic stenting would have changed the surgical course of the patient.