A Fatal Vascular Emergency as a Herald of Occult Malignancy: Emphysematous Aortitis Associated with Colon Adenocarcinoma

ABSTRACTBackground: Emphysematous aortitis is an uncommon form of vasculitis, distinguished by the formation of gas within the aortic wall. This condition is characterised by its high mortality rate and the potential for severe complications. Its association with immunosuppression, diabetes mellitus, advanced atherosclerosis, and previous aortic surgery or endovascular interventions is well-documented. Its occurrence as a paraneoplastic phenomenon associated with underlying malignancy has been reported in the literature in an extremely limited number of cases and is considered an exceptional clinical situation.Case presentation: A 69-year-old male patient presented with dysphonia, accompanied by a cough and chest pain. A Computed Tomography (CT) scan was performed at the time of presentation, revealing the presence of intramural gas foci within the aortic arch and the descending aorta. The patient was initiated on a treatment regimen comprising meropenem and linezolid, with a preliminary diagnosis of emphysematous aortitis. Despite the administration of appropriate broad-spectrum antibiotic treatment, rapid progression was observed, and a rapidly expanding aortic aneurysm measuring approximately 7.5 cm in diameter developed. Consequently, the patient underwent urgent surgical intervention. Further investigations into the aetiology after surgery revealed primary colon adenocarcinoma by positron emission tomography–computed tomography (PET-CT) and colonoscopy.Conclusion: It is incumbent upon clinicians to demonstrate a high level of clinical awareness, considering the possibility of emphysematous aortitis in patients presenting with atypical symptoms. In cases where an infectious aetiology cannot be clearly established, the possibility of a paraneoplastic mechanism should be considered, and a comprehensive and systematic evaluation should be performed to identify underlying malignancies.