A case of inflammatory abdominal aortic aneurysm diagnosed clinically with left common iliac artery aneurysm.

A 64 year-old man visited our hospital with chronic lumbago. On physical examination there was no remarkable findings, but laboratory data presented accelerated erythrocyte sedimentation rate and elevated C-reactive protein level. Abdominal computed tomography (CT) scan showed abdominal aortic aneurysm with thick wall at lower level of renal artery bifurcation. On the enhanced CT scan slight enhancement of the aneurysmal wall which is so-called “mantle sign” was present. Complicated two sacculated aneurysm were shown at the left common iliac artery by intravenous-digital subtraction angiography. Common iliac artery aneurysms were resected because of a risk of rupture. In the operation, strong fibrous changes involving the left ureter from the abdominal aorta to the left common iliac artery were found. Postoperative pathological examination of saccular aneurysm showed no findings of inflammation. A diagnosis of IAAA was made clinically on the basis of clinical findings, laboratory data and image studies without pathological aortic lesion.