Tubercular Aortic Aneurysm with Rupture into Psoas Abscess

A 33 year old Hindu, married female presented with complaints of chronic backache and severe pain in bilateral lower limb. The patient MRI spine revealed a tubercular spine with bilateral psoas abscesses. The patient was referred to us for diagnostic aspiration of abscess under ultrasound guidance.

Tuberculous Aortic Aneurysm

Under ultrasound guidance, abscess aspiration was started with a 20 G LP needle through left sided posterior Para spinal approach. As the needle advanced into the abscess and aspiration started, spurt of haemorrhagic collection came out just after initial aspirate. Doppler signal was traced to identify the source of bleed which revealed an aortic aneurysm with focal leak adjacent to the psoas abscess and the LP needle within the leak/hematoma.

Aspiration was stopped immediately and one ml of isobutyl 2- cyanoacrylate injected immediately though the same syringe adjacent to the aneurysm wall with a hope that the glue will be able to block the leak site.

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