---
title: "Impending Rupture of a Stable Abdominal Aortic Aneurysm After COVID-19 in a 78-Year-Old Man"
id: "pubmed-42920293"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42920293"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42920293/"
doi: "10.12659/AJCR.954216"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Impending Rupture of a Stable Abdominal Aortic Aneurysm After COVID-19 in a 78-Year-Old Man
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42920293
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42920293/)
- **DOI:** [10.12659/AJCR.954216](https://doi.org/10.12659%2FAJCR.954216)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- A 78-year-old man under imaging surveillance had a previously stable **abdominal aortic aneurysm** (AAA) with a maximum short-axis diameter of ~43 mm for 2 years, investigators reported. - The patient developed fever and was diagnosed with **COVID-19** by nasopharyngeal PCR; seven days later he required hospital admission for recurrent fever, cough, poor appetite, and raised inflammatory markers. - Medical history included hypertension, heavy smoking, advanced chronic kidney disease, and diffuse atherosclerotic disease; these comorbidities framed the clinical risk profile. - On admission, C-reactive protein initially decreased but then increased again on hospital day 11; new mild low back pain developed without hemodynamic instability or marked blood pressure rise. - Repeat non-contrast abdominal CT performed 18 days after the COVID-19 diagnosis demonstrated rapid aneurysmal enlargement from 43 mm to 51 mm compared with prior imaging, plus periaortic fat stranding consistent with impending rupture. - The study team observed that urgent **endovascular aneurysm repair** (EVAR) was performed before hemodynamic deterioration; postoperative recovery was stable and the patient was discharged without ischemic or procedural complications. - Authors noted that a previously stable AAA can abruptly destabilize after recent **COVID-19**, and they recommended considering repeat imaging when inflammatory markers rise or new symptoms appear, even if symptoms are mild. - The report did not provide mechanistic data, histopathology, or detailed timing of all imaging studies beyond the intervals reported; no population-level conclusions were drawn because this is a single case report.
## Clinical Analysis & Structured Key Points
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A 78-Year-Old Man With a Previously Stable Atherosclerotic Abdominal Aortic Aneurysm Presenting With Impending Rupture Following COVID-19 [Takeru Hori](https://pubmed.ncbi.nlm.nih.gov/?term=Hori+T&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Daigoro Hirohama](https://pubmed.ncbi.nlm.nih.gov/?term=Hirohama+D&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Ken Kaseda](https://pubmed.ncbi.nlm.nih.gov/?term=Kaseda+K&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Mika Kawagoe](https://pubmed.ncbi.nlm.nih.gov/?term=Kawagoe+M&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Yoshihiro Tomomitsu](https://pubmed.ncbi.nlm.nih.gov/?term=Tomomitsu+Y&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Minoru Yasukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Yasukawa+M&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Chikayuki Morimoto](https://pubmed.ncbi.nlm.nih.gov/?term=Morimoto+C&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Shinichiro Asakawa](https://pubmed.ncbi.nlm.nih.gov/?term=Asakawa+S&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Osamu Yamazaki](https://pubmed.ncbi.nlm.nih.gov/?term=Yamazaki+O&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Yoshifuru Tamura](https://pubmed.ncbi.nlm.nih.gov/?term=Tamura+Y&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Yoshihide Fujigaki](https://pubmed.ncbi.nlm.nih.gov/?term=Fujigaki+Y&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-2 "General Medical Education and Research Center, Teikyo University, Tokyo, Japan."), [Shigeru Shibata](https://pubmed.ncbi.nlm.nih.gov/?term=Shibata+S&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#full-view-affiliation-3 "Division of Health Science Research, Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan.") Affiliations Expand ### Affiliations * 1 Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan. * 2 General Medical Education and Research Center, Teikyo University, Tokyo, Japan. * 3 Division of Health Science Research, Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan. * PMID: **42920293** * DOI: [ 10.12659/AJCR.954216 ](https://doi.org/10.12659/ajcr.954216) Item in Clipboard Case Reports # A 78-Year-Old Man With a Previously Stable Atherosclerotic Abdominal Aortic Aneurysm Presenting With Impending Rupture Following COVID-19 Takeru Hori et al. Am J Case Rep. 2026. Show details Display options Display options Format Abstract PubMed PMID Am J Case Rep Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Case+Rep%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Case+Rep%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920293/) . 2026 Oct 24:27:e954216. doi: 10.12659/AJCR.954216. ### Authors [Takeru Hori](https://pubmed.ncbi.nlm.nih.gov/?term=Hori+T&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Daigoro Hirohama](https://pubmed.ncbi.nlm.nih.gov/?term=Hirohama+D&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Ken Kaseda](https://pubmed.ncbi.nlm.nih.gov/?term=Kaseda+K&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Mika Kawagoe](https://pubmed.ncbi.nlm.nih.gov/?term=Kawagoe+M&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Yoshihiro Tomomitsu](https://pubmed.ncbi.nlm.nih.gov/?term=Tomomitsu+Y&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Minoru Yasukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Yasukawa+M&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Chikayuki Morimoto](https://pubmed.ncbi.nlm.nih.gov/?term=Morimoto+C&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Shinichiro Asakawa](https://pubmed.ncbi.nlm.nih.gov/?term=Asakawa+S&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Osamu Yamazaki](https://pubmed.ncbi.nlm.nih.gov/?term=Yamazaki+O&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Yoshifuru Tamura](https://pubmed.ncbi.nlm.nih.gov/?term=Tamura+Y&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan."), [Yoshihide Fujigaki](https://pubmed.ncbi.nlm.nih.gov/?term=Fujigaki+Y&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-2 "General Medical Education and Research Center, Teikyo University, Tokyo, Japan."), [Shigeru Shibata](https://pubmed.ncbi.nlm.nih.gov/?term=Shibata+S&cauthor_id=42920293)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-1 "Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920293/#short-view-affiliation-3 "Division of Health Science Research, Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan.") ### Affiliations * 1 Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan. * 2 General Medical Education and Research Center, Teikyo University, Tokyo, Japan. * 3 Division of Health Science Research, Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan. * PMID: **42920293** * DOI: [ 10.12659/AJCR.954216 ](https://doi.org/10.12659/ajcr.954216) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract BACKGROUND Abdominal aortic aneurysm (AAA) rupture is a life-threatening condition. Although elective repair is generally guided by aneurysm size, impending rupture can occur when rapid aneurysmal expansion or periaortic inflammatory changes develop before overt hemodynamic deterioration. This report describes the case of a 78-year-old man with a previously stable 43-mm atherosclerotic AAA who presented with impending rupture after coronavirus disease 2019 (COVID-19). CASE REPORT A 78-year-old Japanese man with a known AAA under imaging surveillance developed fever and was diagnosed with COVID-19 by nasopharyngeal polymerase chain reaction testing. Seven days later, he was admitted for recurrent fever, cough, poor appetite, and elevated inflammatory markers. His medical history included hypertension, heavy smoking, advanced chronic kidney disease, and diffuse atherosclerotic disease. The aneurysm had shown minimal growth over 2 years, with a stable maximum short-axis diameter of approximately 43 mm on serial computed tomography. After admission, C-reactive protein levels initially decreased but rose again on hospital day 11, accompanied by new-onset mild low back pain and no marked blood pressure elevation or hemodynamic instability. Repeat non-contrast abdominal computed tomography performed 18 days after COVID-19 diagnosis demonstrated rapid AAA expansion from 43 mm to 51 mm within 2 months, with periaortic fat stranding, consistent with impending rupture. Urgent endovascular aneurysm repair was performed before hemodynamic deterioration. The postoperative course was stable, and the patient was discharged without ischemic or procedural complications. CONCLUSIONS This case shows that a previously stable AAA can abruptly destabilize after recent COVID-19. Repeat imaging should be considered when inflammatory markers rise or new symptoms occur, even when symptoms are mild. 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