A Case of Two Inflammatory Aortic Aneurysms Showing Spontaneous Improvement of the First Aneurysm During Development of the Second One

A 66-year-old man presented with severe abdominal pain which had lasted for 2 days. Computed tomographic (CT) scanning revealed infrarenal abdominal aortic aneurysm (AAA) with a thick soft tissue around aortic walls (mantle sign). Based on the CT finding, the diagnosis was made as inflammatory AAA. Eighteen months later, due to a left hydrocele, the patient received a follow-up CT scan, which revealed spontaneous improvement of AAA with disappearance of mantle sign. It was also documented a newly developed thoracoabdominal aortic aneurysm (TAAA) associated with mantle sign. Loboratory findings revealed slightly elevated levels of erysrocyte sedimentstion rate (17 mm/hr) and fibrinogen (399 mg/dl). An 18F-labeled deoxyglucose (FDG) positron emission tomography (PET) scan showed no FDG uptake in AAA but in TAAA. Subsequent development of two inflammatory aortic aneurysms is rare. In this case, during the development of the second aneurysm, the first one spontaneously improved. The consequence of these two aneurysms suggests that inflammatory reaction associated with this disease may be a local rather than systemic pathology.