Multiple aneurysms

Case contributed by Brendan Cullinane
Diagnosis almost certain


The clinical work-up noted smoking and a pulsatile mass in the right iliac fossa.

Patient Data

Age: 55 years
Gender: Male

The presence of a right common iliac artery aneurysm was confirmed. Further examination reveals an infrarenal abdominal aortic aneurysm, left common iliac artery aneurysm and bilateral popliteal artery aneurysms. There were also bilateral 50-75% stenoses of the proximal internal iliac arteries.

Case Discussion

The patient was referred to a vascular surgeon following detection of a right common iliac artery aneurysm on an abdominal ultrasound at a radiology practice. A scan of the abdominal and pelvic arteries was requested for confirmation. 

It is important to assess the internal iliac arteries for evidence of aneurysmal dilatation as these vessels supply the rectum, internal iliac artery aneurysms are difficult to detect by CTA and are difficult to treat if they rupture. They are often obscured by gas but marked turbulent flow may raise suspicion. Here, peak systolic velocity within the proximal right internal iliac artery is raised indicating a 50-75% stenosis.

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