{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T10:28:05Z","timestamp":1786530485067,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babes\u201d University of Medicine and Pharmacy"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Ruptured common iliac artery aneurysms may mimic urological disease, particularly when retroperitoneal bleeding causes ureteral compression and secondary hydronephrosis. This case is clinically relevant because the first symptom was acute stabbing testicular pain, followed by lumbar discomfort and ultrasound findings suggestive of obstructive uropathy. Case Presentation: A 73-year-old man with arterial hypertension and active smoking presented to the Emergency Department with sudden left lumbar pain that initially radiated to, or was perceived in, the left testicle. The testicular pain resolved spontaneously, but persistent poorly localized lumbar pain continued. He was afebrile and initially hemodynamically stable. Point-of-care ultrasound showed left hydronephrosis, while the abdominal aorta appeared unremarkable. Because the patient looked clinically unwell and the abrupt, stabbing onset was not fully explained by uncomplicated renal colic, contrast-enhanced abdominal and pelvic computed tomography was performed. CT revealed a fissured saccular aneurysm of the left common iliac artery with active contrast extravasation and a large retroperitoneal hematoma compressing the ipsilateral ureter, thereby causing secondary hydronephrosis. The patient underwent urgent endovascular treatment with percutaneous transluminal angioplasty and Bentley stent. Post-revascularization CT showed no further contrast extravasation, and the patient was discharged after seven days without complications. Conclusions: In older patients with cardiovascular risk factors, sudden testicular, flank, or lumbar pain may warrant consideration of retroperitoneal vascular emergencies, even when initial ultrasound suggests a urological diagnosis. In this patient, discordance between the clinical presentation and the initial ultrasound findings prompted contrast-enhanced CT, which enabled diagnosis and timely vascular management.<\/jats:p>","DOI":"10.3390\/reports9030266","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:11:36Z","timestamp":1786525896000},"page":"266","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Acute Testicular Pain as the Initial Manifestation of a Ruptured Common Iliac Artery Aneurysm"],"prefix":"10.3390","volume":"9","author":[{"given":"Cristina Valeria","family":"Tandara","sequence":"first","affiliation":[{"name":"Emergency Department, Emergency Clinical Municipal Hospital, 300254 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7935-4471","authenticated-orcid":false,"given":"Alexandru Cristian","family":"Cindrea","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of General Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Centre for Artificial Intelligence and Big Data in Emergency Medicine and Clinical Research, Department of Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8978-3168","authenticated-orcid":false,"given":"Adina Maria","family":"M\u00e2rza","sequence":"additional","affiliation":[{"name":"Centre for Artificial Intelligence and Big Data in Emergency Medicine and Clinical Research, Department of Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian Adrian","family":"Tandara","sequence":"additional","affiliation":[{"name":"Emergency Department, \u201cPius Brinzeu\u201d Emergency Clinical County Hospital, 300736 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2242-7764","authenticated-orcid":false,"given":"Ovidiu Alexandru","family":"Mederle","sequence":"additional","affiliation":[{"name":"Centre for Artificial Intelligence and Big Data in Emergency Medicine and Clinical Research, Department of Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Surgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.ejvs.2023.11.002","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms","volume":"67","author":"Wanhainen","year":"2024","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1053\/j.semvascsurg.2005.09.007","article-title":"Isolated Iliac Artery Aneurysms","volume":"18","author":"Sandhu","year":"2005","journal-title":"Semin. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ejvs.2020.02.027","article-title":"Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands","volume":"60","author":"Jalalzadeh","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e238995","DOI":"10.1136\/bcr-2020-238995","article-title":"Emergent Endovascular Repair in a Spontaneous Isolated Ruptured Common Iliac Aneurysm: An Important Diagnosis to Remember","volume":"13","author":"Yeung","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1002\/ccr3.2385","article-title":"Successful Endovascular Repair of a Ruptured Isolated Iliac Artery Aneurysm: A Case Report","volume":"7","author":"Kimura","year":"2019","journal-title":"Clin. Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s42155-022-00302-5","article-title":"Bilateral External Iliac Artery Pseudoaneurysms Causing Urinary Obstruction and Acute Renal Failure","volume":"5","author":"Bigarella","year":"2022","journal-title":"CVIR Endovasc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"266","DOI":"10.2459\/JCM.0000000000001437","article-title":"Large Ruptured Isolated Common Iliac Artery Aneurysm Masquerading as Testicular Torsion","volume":"24","author":"Bray","year":"2023","journal-title":"J. Cardiovasc. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"bcr2012006568","DOI":"10.1136\/bcr-2012-006568","article-title":"A Ruptured Left Common Iliac Aneurysm Presenting as Testicular Pain in a 56-Year-Old Man","volume":"2014","author":"Dolan","year":"2014","journal-title":"BMJ Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.avsg.2022.07.001","article-title":"Effect of Endovascular Treatment on Urinary Obstruction Caused by Iliac Artery Aneurysm: A Case Series and Review of the Literature","volume":"87","author":"Zhou","year":"2022","journal-title":"Ann. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"omaf146","DOI":"10.1093\/omcr\/omaf146","article-title":"A Rare Etiology of Right Lower Back Pain in a Young Man: Contained Rupture of the Common Iliac Artery Aneurysm","volume":"2025","author":"Taibi","year":"2025","journal-title":"Oxf. Med. Case Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s12055-021-01283-1","article-title":"Giant Isolated Iliac Artery Aneurysm with Ipsilateral Hydronephrosis Treated with Aneurysm Resection and Extra-Anatomic Bypass","volume":"38","author":"Goyal","year":"2022","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/j.jvir.2018.07.019","article-title":"Primary Endovascular Elective Repair and Repair of Ruptured Isolated Iliac Artery Aneurysms Is Durable\u2014Results of 72 Consecutive Patients","volume":"29","author":"Kobe","year":"2018","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1016\/j.jvs.2021.01.064","article-title":"A Systematic Review on Endovascular Repair of Isolated Common Iliac Artery Aneurysms and Suggestions Regarding Diameter Thresholds for Intervention","volume":"74","author":"Charisis","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1016\/j.jvs.2020.02.038","article-title":"Therapeutic Management of Isolated Internal Iliac Artery Aneurysms","volume":"72","author":"Yang","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.jvs.2022.03.005","article-title":"A Systematic Review and Meta-Analysis of the Clinical Effectiveness and Safety of Unilateral versus Bilateral Iliac Branch Devices for Aortoiliac and Iliac Artery Aneurysms","volume":"76","author":"Cao","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/0002-9343(94)90137-6","article-title":"Ruptured Abdominal Aortic Aneurysm: The Internist as Diagnostician","volume":"96","author":"Lederle","year":"1994","journal-title":"Am. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.jvs.2020.06.047","article-title":"Misdiagnosis of Ruptured Abdominal Aortic Aneurysms Is Common and Is Associated with Increased Mortality","volume":"73","author":"Smidfelt","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1583\/13-4626MR.1","article-title":"Misdiagnosis of Ruptured Abdominal Aortic Aneurysm: Systematic Review and Meta-Analysis","volume":"21","author":"Azhar","year":"2014","journal-title":"J. Endovasc. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/MEJ.0000000000000281","article-title":"Diagnosis of Ruptured Abdominal Aortic Aneurysm: A Multicentre Cohort Study","volume":"23","author":"Metcalfe","year":"2016","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_20","first-page":"75","article-title":"Isolated Common Iliac Artery Aneurysm with Specific Anatomical Considerations","volume":"29","year":"2022","journal-title":"Port. J. Card. Thorac. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Waldman, S.D. (2019). Genitofemoral Neuralgia. Atlas of Common Pain Syndromes, Elsevier.","DOI":"10.1016\/B978-0-323-54731-4.00081-5"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Turner, O.A., Taslitz, N., and Ward, S. (1990). Genitofemoral Nerve Entrapment. Handbook of Peripheral Nerve Entrapments, Humana Press.","DOI":"10.1007\/978-1-4612-4492-9_26"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"bcr2018226577","DOI":"10.1136\/bcr-2018-226577","article-title":"Acute Testicular Pain Secondary to a Leaking Abdominal Aortic Aneurysm (AAA)","volume":"2018","author":"Khan","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1053\/ejvx.2002.0162","article-title":"Testicular Pain\u2014An Unusual Presentation of Ruptured Aortic Aneurysm","volume":"4","author":"Maharaj","year":"2002","journal-title":"EJVES Extra"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"116","DOI":"10.2310\/6670.2008.00003","article-title":"Inflammatory Aneurysm of the Common Iliac Artery Mimicking Appendicitis","volume":"16","author":"Mieog","year":"2008","journal-title":"Vascular"},{"key":"ref_26","first-page":"82","article-title":"Presentaci\u00f3n At\u00edpica Como Abdomen Agudo de Un Aneurisma de Arteria Iliaca Gigante Imitando Colescistitis y Lesi\u00f3n Renal: Reporte de Caso","volume":"31","year":"2024","journal-title":"Cir. Cardiovasc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.1259\/bjr\/36343011","article-title":"Rupture of Renal Artery Aneurysm into the Renal Pelvis, Clinically Mimicking Renal Colic: Diagnosis with Multidetector CT","volume":"80","author":"Devue","year":"2007","journal-title":"Br. J. Radiol."},{"key":"ref_28","first-page":"e99963","article-title":"Chronic Ureteral Compression From a Thrombosed Iliac Artery Aneurysm: A Manifestation of Aortoiliac Aneurysmal Disease","volume":"17","author":"Jalil","year":"2025","journal-title":"Cureus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.clinimag.2013.01.006","article-title":"A Rare Cause of Hydronephrosis: Entrapment Effect of Giant Iliac Artery Aneurysm","volume":"37","author":"Sharifov","year":"2013","journal-title":"Clin. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1007\/s100169900186","article-title":"Ureteropelvic Urinary Extravasation Due to Iliac Artery Aneurysm","volume":"12","author":"Obrand","year":"1998","journal-title":"Ann. Vasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1016\/j.annemergmed.2021.09.070","article-title":"61 Gestalt in Acute Trauma: Evaluating Clinician Accuracy in Predicting Abdominal Injuries Among Trauma Patients","volume":"78","author":"Rodriguez","year":"2021","journal-title":"Ann. Emerg. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1053\/j.jvca.2023.01.002","article-title":"Con: Limitations of POCUS Examination: Be Aware of Overdiagnosis and Undertreatment","volume":"37","author":"Jones","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_33","first-page":"V8","article-title":"Bilateral Common Iliac Artery Aneurysm, a Case Report","volume":"5","author":"Kolster","year":"2020","journal-title":"J. Educ. Teach. Emerg. Med."},{"key":"ref_34","first-page":"105","article-title":"Vascular Point-of-Care Ultrasound","volume":"109","author":"Chrusch","year":"2025","journal-title":"Med. Clin."},{"key":"ref_35","first-page":"182","article-title":"Prospective Study on Factors Delaying Surgery in Ruptured Abdominal Aortic Aneurysms","volume":"43","author":"Acheson","year":"1998","journal-title":"J. R. Coll. Surg. Edinb."},{"key":"ref_36","first-page":"25","article-title":"Going with the Gut How Accurate Is the EP\u2019s First Take?","volume":"37","author":"Shaw","year":"2015","journal-title":"Emerg. Med. News"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/0741-5214(92)90412-2","article-title":"Misdiagnosis of Ruptured Abdominal Aortic Aneurysms","volume":"16","author":"Marston","year":"1992","journal-title":"J. Vasc. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Minotti, B., Treglia, G., Pascale, M., Ceruti, S., Cantini, L., Anselmi, L., and Saporito, A. (2020). Prevalence of Microhematuria in Renal Colic and Urolithiasis: A Systematic Review and Meta-Analysis. BMC Urol., 20.","DOI":"10.1186\/s12894-020-00690-7"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/j.juro.2016.04.076","article-title":"Is Hydronephrosis on Ultrasound Predictive of Ureterolithiasis in Patients with Renal Colic?","volume":"196","author":"Sternberg","year":"2016","journal-title":"J. Urol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"65","DOI":"10.22514\/SV152.092019.10","article-title":"Misleading Presentation of Ruptured Abdominal Aortic Aneurysm and the Role of Point-of-Care Ultrasound for Diagnosis","volume":"15","author":"Keber","year":"2019","journal-title":"Signa Vitae"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.jvs.2007.11.008","article-title":"Isolated Iliac Artery Aneurysms: A Contemporary Comparison of Endovascular and Open Repair","volume":"47","author":"Chaer","year":"2008","journal-title":"J. Vasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.jvs.2010.06.020","article-title":"Midterm Outcome of Endovascular Repair of Ruptured Isolated Iliac Artery Aneurysms","volume":"52","author":"Hechelhammer","year":"2010","journal-title":"J. Vasc. Surg."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/266\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:32:02Z","timestamp":1786527122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":42,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["reports9030266"],"URL":"https:\/\/doi.org\/10.3390\/reports9030266","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]}}}