Aref Obagi MD, Lance Berger MD, Michael P. Carson MD Asymptomatic Elderly Patient With Incidental Inflammatory Abdominal Aortic Aneurysm! Aref Obagi MD, Lance Berger MD, Michael P. Carson MD Jersey Shore University Medical Center, Neptune NJ LEARNING OBJECTVES LABS DISCUSSION Review the epidemiology of Inflammatory Abdominal Aortic Aneurysm (IAAA). Diagnose IAAA in an elderly male with atypical symptoms. IAAA is a rare condition characterized by wall thickening and periaortic fibrosis represents 5-10% of AAA and usually presents at a mean age of 62 vs. 72 for atherosclerotic AAA. Common symptoms include abdominal/back pack, fever, fatigue, tenderness over AAA, obstruction of urinary tract, or elevated ESR. Interestingly, the rate of IAAA rupture is similar to AAA which is 9.4% for aneurysm with diameter range of 5.5 to 5.9 cm and the rate is higher when the diameter increases. CT scan remains the preferred diagnostic tool with high specificity. Treatment options include EVAR vs. open surgical repair. Open surgical repair is associated with higher complication and mortality rate and it's the preferred option for aneurysm diameter that exceeds 5.5 cm. ESR 99 (<20 mm/h) CRP 5.57 (0-0.744mg/dl) CASE PRESENTATION DIAGNOSTIC IMAGING An 81-year-old male with 10 pack-year smoking had a stable 4.1 cm infra-renal atherosclerotic AAA, recurrent syncopal episodes, and hypertension presented with vasovagal syncope. Patient reported 10 lb weight loss and fatigue over 6 months. EXAM: BP: 141/86, HR : 77, Pulsatile mass mid abdomen. Mid-abdominal During hospitalization, repeated CT Chest/Abdomen/Pelvis showed revealed distal infra-renal aortic aneurysm with new evidence of an inflammatory periaortic reaction around the aneurysm down to the distal aorta and proximal iliac vessels. Figure 1: CT scan with contrast showing peri-aortic infiltration (arrow) Figure 2: sagittal view of the descending aorta showing peri-aortic infiltration (arrow) with aneurysmal dilation. REFERENCES DISEASE COURSE 1-David B. Hellmann, MD; David J. Grand, MD; Julie A. Freischlag, MD. JAMA. 2007;297(4):395-400. doi:10.1001/jama.297.4.395. 2-Bajardo, G1, Pecoraro F, Mirabella D, Bellisi MG. Inflammatory abdominal aortic aneurysm (IAAA).Ann Ital Chir. 2009 May-Jun;80(3):171-6. 3- Rubini P1, Bonati L, Parolari A, Spirito R. [Inflammatory abdominal aortic aneurysms]. Minerva Chir. 2001 Jun;56(3):287-98. Patient Underwent successful Endovascular Aortic Repair (EVAR) using 1 stent Endologix AFX main body