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case_images: Flow diagram of literature search according to our methods.
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case_images: The chest X-ray showed an alveolar infiltrate in the middle lobe of the right lung (Figure 2).
case_images: Chest X-ray showing an alveolar infiltrate of 3 by 4 cm (red arrow) in the middle lobe of the right lung.
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case_images: Histological examination (hematoxylin-eosin) via nasal tissue biopsy showing necrotizing vasculitis, inflammatory cell infiltration, and granulomatous reaction which represent suggestive features for GPA (magnification x5).
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case_images: Favorable evolution was also confirmed via nasal biopsy re-examination (Figure 4).
case_images: Histological examination (hematoxylin-eosin) via nasal tissue biopsy after six months of treatment revealing mucinous glandular structures with preserved architecture, moderate lympho-plasmocytic inflammatory infiltrates (with diffuse distribution), moderate interstitial fibrosis, and a few dilated capillary vessels (magnification x20).
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case_images: Chest X-ray showing diffuse bilateral pulmonary infiltrates (red arrow) predominantly affecting the right lung seven years after prior GPA diagnosis.
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case_images: Profile X-ray of the spine showing anomalies of the vertebral body's shape and size with a reduction in the lumbar L1 vertebral body height and concave vertebral deformities:predominantly at lumbar L1 and L3 level (red arrows).
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case_images: (A) Native abdominal CT scan revealing abdominal aorta calcifications and crescent-shaped thickening of the aortic wall (red arrow). (B) Abdominal angiography CT (green arrow = aorta; yellow arrow = parietal fibrosis) at the same level as seen in (A); parietal fibrosis (2/3 of the aortic circumference) was of 13 mm (a length of 27 mm, without hematic extravasation); captured at different levels, these parietal changes might explain the parietal resistance until the moment of emergency. Parietal fibrosis was considered amid the context of chronic inflammation underlying rheumatologic and cardiovascular ailments. (C) Angiography-CT (sections at the same levels).
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case_images: This time, abdominal ultrasound revealed an enlargement of the mentioned hypoechoic para-aortic area, surrounded by a hyperechoic area of inflammatory tissue (Figure 8).
case_images: Abdominal ultrasound revealing a hypoechoic para-aortic area of 3.6 by 1.9 cm, embedded by the hyperechoic inflammatory tissue.
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case_images: Abdominal ultrasound with color Doppler analysis showing the area of the blood extravasation (red arrow).
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case_images: Native abdominal CT showing the enlargement of the peri-aortic area consistent with the diagnosis of a hematoma. This second CT scan was performed without a contrast medium, which was due to the patient's chronic renal failure.
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case_images: Pre-interventional arteriography highlighted the abdominal aorta rupture and the formation of a pseudoaneurysm with a maximum diameter of 2 by 1 cm (Figure 11).
case_images: Pre-interventional arteriography showing the aortic lesion in the distal part of the abdominal aorta that formed an irregularly shaped pseudo-aneurysm (red arrow); the aorta was catheterized by placing a superstiff guidewire at this level. The procedure was followed by the implantation of 2 aortic stents of 2.4 x 4 cm.
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case_images: The control injection showed a complete occlusion of the aortic rupture and the absence of the pseudo-aneurysm loading (Figure 12).
case_images: Stent dilatation with a 40 x 40 mm AndraTec balloon; the final result was optimal, without the extravasation of the contrast substance and restoration of the vascular axis. The two endovascular stents and the control injection showed a complete occlusion of the aortic rupture and the absence of the pseudo-aneurysm loading.
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case_images: The clinical and biological status normalized (Figure 13).