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Aortic aneurysm and Lemmel syndrome

Case contributed by Mohammad Taghi Niknejad
Diagnosis certain

Presentation

Pulsatile upper abdominal mass on physical exam.

Patient Data

Age: 85 years
Gender: Female

Fusiform aneurysmal dilatation of the lower thoracic and upper abdominal aorta is present, measuring 5 cm in maximum diameter and about 8 cm in length. Mild mural thrombosis is observed at the right anterolateral aspect. 

Intra and extrahepatic bile ducts are mildly dilated, and CBD measured 10 mm in caliber. 
A 30 mm diverticulum is evident at the medial aspect of the second portion of the duodenum that seems to be compressed distal of CBD, suggesting Lemmel syndrome.

A few non-enhanced simple cortical cysts are seen in both kidneys.

Degenerative changes as osteophytosis are seen in the lumbar spine.
Grade I spondylolisthesis of L5 on S1 is present. 

Case Discussion

Open repair of the aortic aneurysm was performed with a vascular graft at a referral center. Patient doing well postoperatively.

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