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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.