Large abdominal aortic aneurysm

Case contributed by Mohammad Taghi Niknejad
Diagnosis certain

Presentation

Pulsatile abdominal mass feeling.

Patient Data

Age: 70 years
Gender: Male

Huge fusiform infrarenal abdominal aortic aneurysm is noted, measured about 137mm in length, 111mm in transverse diameter and 98mm in anteroposterior diameter. No mural thrombosis or evidence of rupture is seen. Common iliac arteries also are aneurysmal, accompanied by mural thrombosis especially on the left side.

The left kidney is small with relatively atrophic parenchyma. Moderate hydroureteronephrosis is seen on the left side. Increased wall thickness and enhancement are seen in the distal 5cm the of left ureter. Large exophytic cortical cyst , 104×98mm in diameter, is noted at the upper pole of the right kidney with thin peripheral incomplete calcification.  Several simple cortical cysts also are observed at both kidneys, less than 38mm in diameter.

Increased wall thickness with tumoral infiltration is seen at the rectosigmoid junction, measuring approximately 12cm in length. Surrounding fat stranding and several peri-lesional lymph nodes are noted.

Advanced degenerative changes is seen involving lumbar spine.

Case Discussion

The main findings in this 70 yo patient include: rectosigmoid tumoral infiltration with regional lymphadenopathy, left hydroureteronephrosis due to distal ureteral tumoral infiltration, renal cortical cysts (Bosniak I & IIF), huge abdominal aortic aneurysm with extension to common iliac arteries and prostate enlargement.

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