Unveiling the rare: a case report of lumbar pseudoaneurysm secondary to tuberculous spondylitis.

Introduction and importance: Tuberculous spondylitis may compromise adjacent vascular structures, leading to the formation of tuberculous pseudoaneurysms - vascular lesions resulting from infection-induced destruction of the arterial wall. Despite their infrequency, these pseudoaneurysms carry a substantial risk of rupture and pose considerable diagnostic challenges. Case presentation: A 19-year-old female presented with a painful mass in the right abdominal region, persisting for 2 months. She had been diagnosed with tuberculous spondylitis involving the L1-L2 vertebrae. The initial management included posterior spinal debridement and stabilization from T12 to L4. Despite undergoing surgical intervention and anti-tuberculosis therapy for 8 months, the patient developed a firm, non-pulsatile mass in the right abdominal region. Imaging studies revealed a large retroperitoneal abscess and intraosseous collections. Abdominal CT angiography revealed a right lumbar artery pseudoaneurysm. The vascular lesion was successfully treated by embolization. This was followed by debridement and hematoma evacuation through a lumbotomy. No active bleeding from the pseudoaneurysm was observed during the intraoperative period. Clinical discussion: This case highlights the importance of maintaining a high index of suspicion for tuberculous pseudoaneurysms in patients with tuberculous spondylitis accompanied by adjacent abscesses. In such cases, clinicians should use advanced imaging modalities, including contrast-enhanced MRI or CT angiography, to improve diagnostic accuracy. Early detection of tuberculous pseudoaneurysms enables a staged therapeutic approach, beginning with prompt vascular repair to reduce the risk of rupture before spinal stabilization. Conclusion: Although tuberculous pseudoaneurysm is a rare complication of spinal tuberculosis, timely diagnosis and management are critical to preventing life-threatening sequelae.