Presentation
Acute abdominal pain.
Patient Data
CT-scan shows an important infra-renal abdominal aortic aneurysm with an impressive intra-luminar and extra-luminal air crescent. No communication is seen with the small bowel. There also is circumferential fat stranding, which wasn't seen in previous studies, suggesting a contained rupture of the aneurysm, since there is no extensive retroperitoneal hemorrhage. Moreover, there are extra-luminar air bubbles, which also suggest a possible leak of the aneurysm.
The findings are highly suggestive of an infected abdominal aortic aneurysm with gas-producing bacteria (mycotic thrombi).
There are many other less relevant findings in this patient with a history of Whipple surgery for pancreatic adenocarcinoma. They are not discussed in details here. Pneumobilia is secondary to the recent surgical intervention.
Previous CT-scan (performed 10 weeks earlier, a few week following Whipple's surgery) shows an infra-renal abdominal aortic aneurysm, without air crescent nor peri-aortic fat stranding.
There are many other, less relevant findings, as this CT-scan was done in the post-operative period of a Whipple surgery for pancreatic adenocarcinoma. There is a post-operative collection near the surgical bed, which completely regressed in later studies.
Case Discussion
Endocarditis was later confirmed and the patient was immediately referred to the team of vascular surgery.