Title : Mycotic multilobed lumbar artery pseudoaneurysm resulting from epidural and psoas abscess embolized with NBCA glue: A case report
Abstract:
Background: Lumbar artery pseudoaneurysm is a rare vascular pathology, with infective (“mycotic”) cases exceptionally uncommon. Only three cases of infective lumbar artery pseudoaneurysm have previously been reported. We describe a unique case of multilobed mycotic lumbar artery pseudoaneurysm associated with epidural and psoas abscesses, managed successfully with endovascular embolisation using n-butyl cyanoacrylate (NBCA) glue.
Case Presentation: A 47-year-old man with a history of intravenous drug use presented with sepsis, progressive back pain, and pyrexia. Imaging demonstrated epidural and right psoas abscesses with methicillin-sensitive Staphylococcus aureus bacteraemia. Despite intravenous antibiotics, interval CT mesenteric angiography demonstrated enlargement of the psoas abscess and development of two multilobed pseudoaneurysms arising from the right L4 lumbar artery, alongside a right iliac vein thrombus. Endovascular embolisation was performed via left common femoral artery access using a microcatheter technique. NBCA glue diluted 1:3 with lipiodol was injected to occlude the pseudoaneurysm sac and outflow vessels.
Results: Angiography confirmed complete exclusion of the pseudoaneurysm with preservation of the proximal parent vessel. No residual filling was identified post-embolisation. The patient subsequently improved clinically, inflammatory markers normalised, and antimicrobial therapy was de-escalated. Anticoagulation was commenced safely following haemorrhage control. At three-week follow-up, the patient remained clinically well without evidence of recurrent bleeding.
Conclusion/Findings: Infective lumbar artery pseudoaneurysm should be considered in patients with psoas or epidural abscesses who deteriorate clinically, develop enlarging collections, or demonstrate falling haemoglobin despite antimicrobial therapy. This case represents the first reported use of NBCA glue for treatment of a mycotic lumbar artery pseudoaneurysm and highlights its utility in infected, friable vascular lesions where permanent intravascular hardware may be undesirable.
Implications: Early vascular imaging and consideration of endovascular management are important in complex spinal and psoas infections.
Disclosure: The authors declare no conflicts of interest.
