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.

Keywords: Aneurysm, Cardiovascular Diseases, Case Reports, COVID-19, endovascular aneurysm repair, inflammation