Infected abdominal aortic aneurysm

Case contributed by Dr Maxime St-Amant

Presentation

Acute abdominal pain.

Patient Data

Age: 70
Gender: Male
Modality: CT

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.

10 months earlier

Modality: CT

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.

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Case Information

rID: 19419
Case created: 7th Sep 2012
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

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