Presentation
Abdominal pain and distension.
Patient Data
Oral contrast enhanced study.
Findings:
abdominal aortic aneurysm with a maximal diametre of 47 mm; aorto bi-femoral stent noted in the infra-renal abdominal aorta
eccentric soft tissue density in the anterolateral aspect of the terminal abdominal aorta measuring 20 mm in axial thickness
stranding of the retro-peritoneal fat planes
multiple prominent para-aortic lymphnodes
Other findings:
further aneurysm involving the left external iliac artery
small saccular aneurysm in the proximal left common iliac artery
large right sided pleural effusion
calcified bilateral pleural plaque
borderline cardiomegaly
pacing wires within the heart
scattered free fluid within the peritoneum
bilateral renal atrophy
bilateral psoas major muscle atrophy
Findings are consistent with an infected aorto-bifemoral stent.
Case Discussion
Peri-graft infections are a well-recognized complication of endovascular abdominal aortic aneurysm repair. This patient was found to have positive Listeria blood cultures. The patient's CRP was elevated.
Soft tissue stranding around the aorta is suggestive of inflammation. The soft tissue densities are not circumferential or symmetrical. Moderate stranding of the retroperitoneal fat planes and prominent lymph nodes help to secure the diagnosis.