We describe our surgical experience of inflammatory abdominal aortic aneurysm (IAAA) in a 54-year-old man. Computed tomography (CT) with contrast enhancement revealed an infrarenal abdominal aortic aneurysm with marked thickening of the aneurysmal wall (mantle core sign) and left hydronephrosis. The left ureteral stenting was performed. Preoperative laboratory findings showed high levels of serum IgG4. The IAAA was removed and replaced with a woven-Dacron graft in situ. Histological examination revealed the IgG4 positive plasma cell, and demonstrated IAAA associated with IgG4. The postoperative serum IgG4 was reduced, but remained high. The postoperative CT revealed new right hydronephrosis, and the ureteral stent was performed. The mantle sign reduced in CT scan after steroid therapy. IAAA with hydronephrosis seems to be associated with IgG4-related sclerosing disease. In this case, the levels of serum IgG4 seems to be a good index for treatment efficacy.

The patient was 62-year-old woman was brought to the emergency room with chest pain and dyspnea. Computed tomography revealed a hematoma around the ascending aorta, a notch in the aortic wall, pericardial effusion and a hematoma around the pulmonary artery. We diagnosed early thrombotic type of acute aortic dissection. An ascending aorta replacement was performed via median sternotomy under hypothermic circulatory arrest. Upon operation, there was a 1.0 cm intimal tear just above the left main trunk and there was no specific evidence of aortic dissection. So we diagnosed spontaneous aortic rapture. Her postoperative course was uneventful and she was discharged 18 days after surgery.