Case Report Bone Deformities as a Complication of Giant Thoracic Aortic Aneurysm Ahmet Aslan, MD 1 , Yig ˘ itcan Kartal, MD 1 , Ercan Ayaz, MD 2 , Mine Aslan, MD 1 , Safiye Sanem Dereli Bulut, MD 1 , Mehmet Ali Ag ˘ ırbas ¸lı, MD 3 , and Aslıhan Semiz Oysu, MD 1 Abstract The contained rupture of thoracic aortic aneurysm and related bone deformities is a rare condition. The diagnosis is critical due to potential and fatal complications. Radiologic evaluation is required to show the location, extension, and complications. Herein we present the X-ray radiography, ultrasonography, computed tomography, and magnetic resonance images of a giant dissected and contained rupture of the thoracic aortic aneurysm. The aneurysm destructed the adjacent vertebrae and rib, resulting in compression of dural sac and spinal cord, and obliteration of the neural foramina. Our case demonstrates a gigantic expansion of an aneurysm (14 cm) with chronic skeletal complications. Keywords aortic aneurysm, aortic dissection, radiology, computed tomography angiography, magnetic resonance imaging Introduction Thoracic aortic aneurysm (TAA) may include adjacent bone deformities secondary to infections or inflammatory dis- eases. 1 But associated bone deformities caused by the aneur- ysm itself are rare. 1,2 Herein we present X-ray radiography, ultrasonography, computed tomography, and magnetic reso- nance imaging (MRI) findings of a giant, dissected, and con- tained rupture of TAA. The aneurysm destructed vertebral body and extended into the neural foramina mimicking symp- toms of a herniated disc. The case demonstrates the utility of imaging methods in the diagnosis of a giant and compli- cated TAA. Case Report A 60-year-old male with nausea, chest pain, and hemoptysis was admitted to the emergency service. He had complaints of left arm and shoulder pain for several years. His medical his- tory included Bentall procedure (5 years ago), heart failure, chronic renal failure, hypertension, and Alzheimer disease. He was afebrile on presentation. The neurological examination revealed moderate weakness in the left arm. Laboratory results showed that serum D-dimer and brain natriuretic peptide levels were elevated. The complete blood count, coagulation para- meters, serum C–reactive protein concentration, and erythro- cyte sedimentation rate were within normal limits. The posterior–anterior chest radiography revealed widening of the mediastinum, bilateral pleural effusion, and an 11 Â 11 cm size mass in the mid-upper zone of the left hemithorax with the erosion of the left side of his middle thoracic vertebra (Figure 1). Computed tomography angiography was performed and displayed a 14-cm size giant aneurysm of the descending aorta with dissection flap and eccentric mural thrombus (maximum thickness 55 mm) with no air in the sac (Figure 2). The dissection flap started from the aortic arch to the right main carotid artery superiorly and the suprarenal part of the abdominal aorta inferiorly without a sign of contrast extravasation (DeBakey type 1 aortic dissection). The aneur- ysm extended through subcutaneous tissue at the level of the fifth thoracic vertebra (Figure 2). Computed tomography angiography and MRI also depicted bone lysis in the posterior part of the fifth rib and the left half of the fourth to seventh thoracic vertebra (Figures 2 and 3). The aneurysm destroyed the left neural foramen, compressed the dural sac, and nar- rowed the spinal cord. The margins of vertebral erosions were sclerotic, and the posterior aortic wall was not clearly 1 Department of Radiology, U ¨ mraniye Training and Research Hospital, U ¨ mra- niye, Istanbul, Turkey. Ahmet Aslan is now with the Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey 2 Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey 3 Department of Cardiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey Corresponding Author: Ahmet Aslan, Department of Radiology, Medical School of Istanbul Medeniyet University, Kadikoy, Istanbul 34722, Turkey. Email: aslahmet@gmail.com Vascular and Endovascular Surgery 2017, Vol. 51(5) 312-315 ª The Author(s) 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1538574417702776 journals.sagepub.com/home/ves