Multiple abdominal viscera thromboembolic infarcts
Citation, DOI & case data
Patient in ICU post extensive vascular surgery to abdominal aorta repair due to a mycotic aneurysm (MSSA bacteremia).
CTA Abdomen and pelvis (selected images)
Loading Stack -
0 images remaining
Thoracic aorta graft involving the arch and proximal descending segments with a residual aneurysm arising from the left aspect of the aortic arch. No evidence of endoleak. Retro-esophageal and retrotracheal bypass graft communicating the right external carotid artery to the left common carotid and subclavian arteries. The graft within the distal descending aorta until just before the celiac trunk now contains partially occlusive eccentric thrombus located anteriorly, measuring approximately 6.6cm in length. No evidence of endoleak. There has been the correction of the focal aneurysmal dilatation of the abdominal aorta at the level of the superior mesenteric artery.
The origin of the celiac trunk, SMA, and renal arteries are capacious and opacify normally. Circumferential non-significant narrowing is now seen at the distal aspect of the distal aortic anastomosis with further infrarenal atheromatous calcification extending into the common iliac arteries. Central arterial line placed in the left common femoral artery. Portal vein, superior mesenteric vein, and inferior vena cava appear patent. Central venous line within the left common femoral vein.
Multiple ill-defined areas of low attenuation scattered through the periphery of the liver and spleen parenchyma are likely regions of infarction. The right kidney is edematous and shows only patchy medullary and thin capsular enhancement consistent with a diffuse infarct. Similar focal infarct appearances noted within the left kidney inferior moiety. Patchy infarcts also pointed out in both adrenal glands. The bowel is not dilated and has normal wall enhancement. Small amount of free intraperitoneal fluid. Pneumoperitoneum is likely related to the recent surgery. Bilateral pleural effusions and partial lower lobes collapse with superimposed consolidation at the right base and patchy infiltrates right upper lobe laterally. The endotracheal tube is a good position. Airways are unremarkable. The nasogastric tube in situ.
Multiple segmental/subsegmental occlusive and non-occlusive pulmonary emboli within the right lower lobe and small volume non-occlusive PEs in the right upper lobe. No radiological features of right heart strain. Some of the patchy consolidation in the right lower lobe may reflect pulmonary hemorrhage secondary to PE in the correct clinical context. Infarction is felt less likely.
This is a busy CT scan with a lot of things going on, but the most interest findings are the multiple visceral infarcts involving the liver, spleen, adrenal glands, and both kidneys that are likely thromboembolic sequelae in this clinical context.
3 article feature images from this case
16 public playlist include this case
- GIT full reports by Alzahraa Abouelnadar Abouhelal
- A 2021 long by Dr Abdullah Hajar
- Genitourinary FRCR 2B by Dr Feras Salhi
- Vasculara by Dr Bența Marius
- RADIO EXAM 3 by edioardo bonamano
- UG Kidney by Cary MacMillan
- interesting by mohammad arjmand
- Vascular emergencies by Dr Osamah A. A. Alwalid
- gastrointestinal by mohammad arjmand
- VIVA by Dr Mustafa Elsayed Elhagar
- Abdomen by Ammar jiraki
- CTAP by Ms Sameera Sharma
- URO by Popovici Alexandra
- Body by Dr Thomas M. Anderson ◉
- CT by Chris Dud
- Liver Prokop by Stefan Teodoru-Saman