Isolated abdominal aortic dissection: Key role of computed tomography in diagnosis and management, and the etiological dilemma (spontaneous vs iatrogenic)—case report

Isolated infrarenal abdominal aortic dissection (IAAD) is a rare vascular condition confined to the infrarenal segment of the abdominal aorta, often presenting with nonspecific symptoms that make clinical diagnosis difficult. We report the case of a 67-year-old hypertensive man with a history of femoral coronary angioplasty and L4-L5 lumbar disk surgery who presented with intermittent lower-limb claudication. CT angiography demonstrated a strictly infrarenal aortic dissection at the level of the prior lumbar surgery, characterized by an intimal flap separating a preserved true lumen from a well-defined false lumen extending to the aortic bifurcation, associated with an aneurysmal dilatation and no suprarenal or iliac artery involvement. Multiplanar and 3-dimensional reconstructions were essential for precise morphological assessment, evaluation of distal perfusion, and therapeutic decision-making. This case highlights the atypical clinical presentation of IAAD and underscores the pivotal role of imaging in diagnosis and management planning, while suggesting that prior femoral coronary angioplasty may represent a contributing factor; early recognition is crucial to guide appropriate conservative or endovascular treatment and optimize patient outcomes.