case_images: PMC11706080_01
case_images: Initial presentation of this case. a and b, Plain radiographs revealing the implanted stent graft at the proximal descending thoracic aorta. c and d, Computed tomography of the aorta and thoracic spine show bony erosion into the T5-T7 vertebral bodies. e and f, Magnetic resonance imaging of the thoracic spine confirms a perianeurysmal outpouching lesion eroding into the T5-T7 vertebral bodies due to pulsating pressure
case_images: 12891_2024_8265_Fig1_HTML.jpg
case_images: PMC11706080_01_12891_2024_8265_Fig1_HTML.jpg
case_images: Fig1
case_images: Plain radiographs detected the previously implanted stent graft at the proximal descending thoracic aorta (Fig. 1a and b). Computed tomography (CT) of the aorta and thoracic spine showed bony erosion into the T5-T7 vertebral bodies (Fig. 1c and d). Magnetic resonance imaging (MRI) of the thoracic spine confirmed a perianeurysmal outpouching lesion eroding into the T5-T7 vertebral bodies due to pulsating pressure (Fig. 1e and f).
case_images: Progression of the thoracic vertebral body erosion in this case. a, Immediately after thoracic endovascular aortic repair (TEVAR), there was no contact between the thoracic aorta lesion and the thoracic vertebral body. b, At a 1.5-year follow-up visit after TEVAR, computed tomography (CT) revealed an increased size of the descending aorta, which was in contact with the thoracic vertebral body. c, At a 3-year follow-up visit after TEVAR, CT showed the perianeurysmal outpouching lesion involving T5 and T6. d-f, At a 4-year follow-up visit after TEVAR, CT revealed a more aggravated perianeurysmal outpouching lesion, and three-dimensional reconstruction of CT data revealed that an anterolateral portion of the thoracic vertebra body had eroded at T5-T7
case_images: 12891_2024_8265_Fig2_HTML.jpg
case_images: PMC11706080_01_12891_2024_8265_Fig2_HTML.jpg
case_images: Fig2
case_images: The progression of the thoracic vertebral body erosion is presented in Fig. 2. After TEVAR procedure, there was no contact between the thoracic aorta lesion and the thoracic vertebral body (Fig. 2a). At a 1.5-year follow-up visit after TEVAR, CT revealed an increased size of the descending aorta, which was in contact with the thoracic vertebra body (Fig. 2b). At a 3-year follow-up visit after TEVAR, CT showed a perianeurysmal outpouching lesion involving T5 and T6 (Fig. 2c). At a 4-year follow-up visit after TEVAR, CT revealed a more aggravated perianeurysmal outpouching lesion (Fig. 2d), and three-dimensional CT reconstruction revealed that an anterolateral portion of the thoracic vertebra body was eroded at T5-T7 (Fig. 2e and f).
case_images: Aggravation of lesion at 3-month follow-up in this case. a-e, Three months later after surgery, follow-up computed tomography of the aorta showed an aggravated perianeurysmal outpouching lesion at the proximal descending thoracic aorta eroding into the T5-T7 vertebral bodies and adjacent left sixth and seventh ribs due to pulsating pressure from the complicated thoracic aortic aneurysm. f-j, Magnetic resonance imaging showed left neural foramen involvement at T5-T6 and T6-T7 and erosion of more than half of the vertebral body at T6 and T7
case_images: 12891_2024_8265_Fig3_HTML.jpg
case_images: PMC11706080_01_12891_2024_8265_Fig3_HTML.jpg
case_images: Fig3
case_images: Three months later, follow-up CT of the aorta showed an aggravated perianeurysmal outpouching lesion at the proximal descending thoracic aorta eroding into the T5-T7 vertebra bodies and adjacent to the left sixth and seventh ribs due to pulsating pressure from the complicated thoracic aortic aneurysm, presenting the type 1b of endoleak (Fig. 3a-e). MRI showed left neural foramen involvement at T5-T6 and T6-T7 (Fig. 3f and g) and erosion of more than half of the vertebral body at T6 and T7 (Fig. 3h-j).
case_images: Surgical treatment in this case. a and b, Considering the rapid progression of this disease, posterior instrumentation and fusion from T3-T9 were performed to support the stability of the thoracic spine. c, Follow-up computed tomography of the aorta after posterior fusion showed remnants of the perianeurysmal outpouching lesion from endo-leakage after thoracic endovascular aortic repair (TEVAR). d-f, TEVAR was performed and significantly decreased the lesion remnants
case_images: 12891_2024_8265_Fig4_HTML.jpg
case_images: PMC11706080_01_12891_2024_8265_Fig4_HTML.jpg
case_images: Fig4
case_images: Given the ongoing vertebral erosion, pedicle screw instrumentation and fusion (with resected autogenous bone and demineralized bone matrix) from T3-T9 by posterior approach were performed to support the stability of the thoracic spine, as half of the vertebral body was preserved (Fig. 4a and b). A follow-up CT scan of the aorta after posterior fusion revealed remnants of the perianeurysmal outpouching lesion. (Fig. 4c). TEVAR was performed (Fig. 4d and e) and significantly decreased the lesion remnants (Fig. 4f).