Abstract
A 66-year-old man who suffered from intermittent abdominal and back pain underwent medical examinations at our hospital. A high value of leukocyte, inflammatory reaction and IgG4 was detected, and computed tomography demonstrated that there was thickened soft tissue around the abdominal aorta which extended to the superior mesenteric artery and the renal arteries. He was given a diagnosis of retroperitoneal fibrosis, and prednisolone (PSL) was administered. Although the decrease in thickness of the soft tissue around the aorta was seen, the enlargement of the aorta mainly near the orifice of the celiac artery was shown. We were consulted on this thoracoabdominal aortic aneurysm (Crawford type IV) at this time, and considered that this aneurismal change had occurred secondary to chronic periaortitis. In a few weeks, the rapid expansion of this aneurysm was occurred, so we planned early surgical treatment after tapering of PSL. He underwent graft replacement of thoracoabdominal aorta with rifampicin-bonded graft, because the infection could not be denied as a cause of this aneurysmal change. Although Streptococcus pneumoniae was detected in the specimens from the periaortic tissue, false lumen and aortic wall in the culture test, he had a good post operative course with prolonged antibiotic therapy.
