title: Hard to diagnose and potentially fatal: slow aortic erosion post spinal fusion.
abstract: BACKGROUND
  Delayed aortic injuries are a rare, but well-recognized complication of spinal surgery. They are a result of slow erosion of osteosynthesis material into the aorta. Although this is a life-threatening complication, patients might present years later with nonspecific symptoms.
  
  
  OBJECTIVE
  A complex case of slow aortic injury after thoracic spinal surgery is presented, which highlights the challenges involved in diagnosis and treatment.
  
  
  METHODS
  A 62-year-old man had a T6 vertebrectomy and T5-7 anterior spinal fusion for multiple myeloma 5 years earlier. Two years postoperatively, the patient developed intermittent hemoptysis that triggered several presentations to the emergency department and consecutive hospital admissions during a 3-year period. All investigations, including endoscopy, bronchoscopy, and repeated chest computed tomography (CT) scans, were unremarkable. Eventually, the patient presented with frank hemoptysis associated with severe left-sided chest pain. Urgent CT angiography revealed a pseudoaneurysm measuring 34 × 20 mm at the level of the vertebrectomy. The patient underwent emergency surgery and an endoluminal stent graft was successfully placed. The patient remains well after 6 months.
  
  
  CONCLUSIONS
  The close proximity of the aorta and spine entertains the risk of aortic injury associated with vertebral osteosynthesis. Long-term complications of slow aortic erosion are extremely difficult to diagnose. The presented patient suffered from an undetected bronchio-aortic fistula with consecutive pseudoaneurysm formation and rupture. Awareness of slow aortic erosion is important for correct diagnostic pathways and subsequent early diagnosis to ensure a positive outcome for the patient.
authors.affiliation: Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Edmond W K
authors.initials: EW
authors.lastname: Ip
authors.affiliation: Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Bourke
authors.affiliation: Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stacey
authors.affiliation: Emergency Department, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Begley
authors.affiliation: Department of Vascular and Endovascular Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Jens C
authors.initials: JC
authors.lastname: Ritter
mesh_terms: D017541:Aneurysm, False / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D001011:Aorta / Q000293:injuries*; D002637:Chest Pain / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000009:adverse effects*; D015607:Stents; D013904:Thoracic Vertebrae
keywords: aorta; bronchial fistula; endovascular procedures; pseudoaneurysm; spine surgery; thoracic aorta injury