AA amyloidosis complicating an inflammatory abdominal aortic aneurysm

Ureteral compromise by periaortic fibrosis secondary to abdominal aortic aneurysm was first described by James w1x in 1935. Subsequently, numerous articles appeared in the medical literature describing similar cases. Inflammatory abdominal aortic aneurysm (IAAA) is a clinico-pathologic entity that comprises about 5–10% of abdominal aortic aneurysms w2x. Characteristic features of IAAA are excessive thickening of the aneurysmal wall and a dense, inflammatory, fibrotic reaction in the retroperitoneum that incorporates adjacent structures. Retroperitoneal fibrosis is a fibrotic process with progressive encasement and compression of the retroperitoneal region from the renal pedicles to the pelvic structures. Fibrous encasement of the ureters eventually leads to ureteral obstruction, hydronephrosis and varying degrees of renal failure w3x. Patients with an IAAA frequently present with back pain, significant weight loss and elevated erythrocyte sedimentation rate, and computed tomography (CT) reveals a thickened, often calcified aortic wall and a mass of periaortic inflammatory tissue w4–6x. In this report, we describe a patient with amyloidosis who presented a different complication due to IAAA. According to our knowledge, IAAA with amyloidosis has never been reported. Case