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When a juxtarenal aneurysm raises an infectious concern

A rapidly expanding saccular juxtarenal aneurysm in an elderly patient, accompanied by unexplained weight loss and an inflammatory response, raises important questions about both its underlying cause and the optimal treatment strategy. 

In this clinical case, the multidisciplinary team faced the challenge of managing a 75-mm juxtarenal aneurysm with features raising suspicion of an infectious process. 

What treatment strategy would you choose?

Martina Cambiaghi
Martina Cambiaghi
Hospital Pellegrin - Bordeaux, France / University of Brescia
Vascular surgeon
Part I - Case presentation

A rapidly expanding aneurysm in a symptomatic patient

  • A 73-year-old woman with hypertension, type 2 diabetes and chronic kidney disease (eGFR 46 mL/min/1.73 m²) presented with a 7-kg weight loss over 2 months.
  • At the same time, her saccular juxtarenal aneurysm had expanded by 2 cm, reaching 75 mm in diameter.
2cm sac expansion of sacciform juxtarenal aneurysm up to 75mm

Multidisciplinary evaluation

  • The patient was afebrile at presentation.
  • Laboratory blood testing showed an elevated inflammatory response, with:
    • CRP: 63 mg/L
    • WBC: 12 × 10⁹/L
  • An extensive infectious work-up was performed, including:
    • Four sets of blood cultures
    • Pneumococcal urinary antigen testing
    • Serologies for Bartonella, Brucella, Q fever and Rickettsia
    • Immunological serology
  • Chest imaging revealed left lower-lobe pneumonia.
AngioTC preop

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