A previously stable 43-mm atherosclerotic AAA abruptly expanded to 51 mm with periaortic fat stranding (impending rupture) after COVID-19 in a 78-year-old man, and urgent EVAR before hemodynamic deterioration led to an uncomplicated recovery; the authors conclude that repeat imaging should be considered when inflammatory markers rise or new symptoms occur, even if mild.
Key Findings
Results
A 78-year-old man with a known, previously stable 43-mm atherosclerotic AAA developed impending rupture after recent COVID-19.
The aneurysm had shown minimal growth over 2 years, with a stable maximum short-axis diameter of approximately 43 mm on serial CT.
He was diagnosed with COVID-19 by nasopharyngeal PCR after developing fever, and was admitted 7 days later with recurrent fever, cough, poor appetite, and elevated inflammatory markers.
His history included hypertension, heavy smoking, advanced chronic kidney disease, and diffuse atherosclerotic disease.
Results
Repeat CT 18 days after COVID-19 diagnosis showed rapid AAA expansion from 43 mm to 51 mm within 2 months with periaortic fat stranding.
The imaging was non-contrast abdominal CT.
The findings were described as consistent with impending rupture.
The expansion occurred in a patient whose aneurysm had previously been stable over 2 years of surveillance.
Results
Impending rupture presented with only subtle clinical signals: a secondary rise in C-reactive protein and new mild low back pain, without hemodynamic instability.
C-reactive protein levels initially decreased after admission but rose again on hospital day 11.
The rise coincided with new-onset mild low back pain.
There was no marked blood pressure elevation or hemodynamic instability.
Results
Urgent endovascular aneurysm repair (EVAR) performed before hemodynamic deterioration resulted in an uncomplicated outcome.
The postoperative course was stable.
The patient was discharged without ischemic or procedural complications.
Conclusions
The authors conclude that a previously stable AAA can abruptly destabilize after recent COVID-19, and that repeat imaging should be considered when inflammatory markers rise or new symptoms occur.
The recommendation applies even when symptoms are mild.
The report notes that elective repair is generally guided by aneurysm size, but impending rupture can occur with rapid expansion or periaortic inflammatory changes before overt hemodynamic deterioration.
This is a single case report, so a causal link between COVID-19 and the expansion is suggested by temporal association rather than established.
What This Means
This case report describes a 78-year-old man who had a known bulge in his abdominal aorta (an abdominal aortic aneurysm) that had stayed stable at about 43 mm for two years. He had several risk factors, including high blood pressure, heavy smoking, advanced kidney disease, and widespread artery hardening. After he caught COVID-19 and was hospitalized with fever and cough, his blood inflammation marker (CRP) first fell and then rose again, and he developed mild low back pain.
A repeat CT scan showed the aneurysm had grown quickly from 43 mm to 51 mm within about two months and was surrounded by inflammatory changes in the fat around the aorta, signs of impending rupture. Doctors performed an urgent minimally invasive stent-graft repair (EVAR) before his blood pressure or circulation became unstable. He recovered without complications and went home.
This research suggests that an aneurysm that has been stable can change rapidly after a recent COVID-19 infection, and that mild symptoms such as a new back pain or a renewed rise in inflammation markers may be early warnings. Because this is a single case, it cannot prove COVID-19 caused the expansion or say how often this happens. It does suggest that doctors may want to consider repeat imaging in patients with known aneurysms who develop such signs.
Hori T, Hirohama D, Kaseda K, Kawagoe M, Tomomitsu Y, Yasukawa M, et al.. (2026). A 78-Year-Old Man With a Previously Stable Atherosclerotic Abdominal Aortic Aneurysm Presenting With Impending Rupture Following COVID-19.. The American journal of case reports. https://doi.org/10.12659/AJCR.954216