Endoleak - type II

Case contributed by Matt Dentry

Presentation

Patient presented with left lower quadrant abdominal pain and fever, ?diverticulitis

Patient Data

Age: 80 years
Gender: Male

CT abdomen and pelvis PV and delayed

ct

There are areas of hyperdensity contained within the aneurysmal sac suspicious for a type II endoleak. There is increased density within the fat relating to the left side of the aneurysmal sac concerning for rupture. Given the history of fever the possibility of a ruptured mycotic aneurysm cannot be excluded.

Prior CT abdo

ct

Increase in the size of the native abdominal aortic aneurysm sac with appearance raising the possibility of endoleak. Now measures 78.7 x 62.9mm and previously measured at 74.4 x 55mm.

Abnormal thickening of the colon noted with appearance highly suggestive of underlying colitis.

Case Discussion

The patient presented with increasing left lower abdominal pain and associated with fevers. He had been transferred from a peripheral site for CT scanning.

The diagnosis was made of type II endoleak with suspicious for mycotic aneurysmal rupture.

The patient had previous CT from 2 years prior suspicious for endoleak but was unfortunately lost to follow up. 

He was admitted under vascular for ongoing care. On angiogram a patent Riolan artery leading the IMA to feed the sac. This was coiled with good result. Subsequently, a small branch of the internal iliac artery feeding small collaterals which then led into a left lumbar vessel going towards the aneurysm sac was also detected. This was also coiled.

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