Leaking abdominal aneurysm

Case contributed by Hugo Neves (RT)

Presentation

Severe acute abdominal pain and increased amylase. Suspicion of pancreatitis.

Patient Data

Age: 80 years
Gender: Male
ct

CT of the abdomen demonstrates a large infrarenal saccular aneurysm of the abdominal aorta projecting towards the left with 81mm in AP diameter with a length of 75mm. Much of the lumen is filled with thrombus, with contrast passing into the thrombus at the superior margin of the aneurysm, in close proximity to the outer wall. Although no contrast extravasation can be identified, extensive hyperdense fluid is present in the retroperitoneum, posterior to the aneurysm. 

The left kidney demonstrates hydronephrosis and reduced enhancement of the cortex, with distortion and compression of the renal vessels. 

Annotated image

The large left sided aortic aneurysm sac (red dotted line) is mostly filled with thrombus ( * ). At the superior margin, contrast (blue arrows) can be seen passing between the thrombus and the wall of the aneurysm. Extensive retroperitoneal hyperdense fluid is present, consistent with blood (green).

The left kidney (yellow dotted line) is hydronephrotic, and this combined with direct compression and compression of the renal vessels by the aneurysm demonstrates less contrast enhancement than the right kidney. 

Case Discussion

This case illustrates how massive abdominal aortic aneurysms can be, and how depending on their location and the direction of leak, presentation can mimic other causes of acute abdominal pain; in this case pancreatitis. 

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