Aortocaval fistula

Case contributed by Matt Dentry


Lower abdominal pain and feeling unwell for 24 hours in the setting of a known abdominal aortic aneurysm.

Patient Data

Age: 85 years
Gender: Male

CT abdominal angiogram


Large infrarenal fusiform abdominal aortic aneurysm, demonstrating maximum transverse diameter of 10.3 cm and AP diameter of 9.8 cm. The craniocaudal extent is 15.6 cm, with the superior extent commencing at approximately the level of the renal arteries and the distal portion extending to the aortic bifurcation. There is a contained rupture of the aortic aneurysm into the IVC, with premature contrast opacification of the IVC and common iliac veins, i.e. aortocaval fistula. This also accounts for the poor contrast opacification of the iliac arteries on the arterial phase. No evidence of active hemorrhage into the retroperitoneum.

Case Discussion

Patient with known abdominal aorta aneurysm presented to the emergency department with 24 hours of increasing abdominal pain. 

A contained rupture of the aortocaval fistula was found on CT.

The patient was discussed with the vascular unit at the local referral center and the decision was made not to progress with surgery. He passed away several hours later.

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