Presentation
Abdominal pain and distension ? bowel obstruction. Patient is allergic to contrast.
Patient Data
Saccular aortic aneurysm arising from the abdominal aorta near the bifurcation.
A large retroperitoneal hematoma at the left side of the pelvic sidewall extending to the left paracolic gutter. The hematoma demonstrates a fluid-fluid level with adjacent fat stranding. Hyperdense fluid is present in the perihepatic space in keeping with some intraperitoneal hemorrhage.
Other findings :
The right kidney is mildly atrophic, the left is markedly atrophic with mild left hydronephrosis and hydroureter. Left adrenal gland demonstrates a nodule.
A large saccular aneurysm arises from the distal abdominal aorta at the level of the aortic bifurcation measuring 25 x 27 x 30 mm. It demonstrates a crescentic cap of mural thrombus due to recent hemorrhage. The left retroperitoneal pelvic sidewall hematoma is again demonstrated. There is no contrast extravasation from the aneurysm to suggest active bleeding at the time of scanning.
Case Discussion
This case was challenging to diagnose as the patient presented with non-specific symptoms that were clinically thought to be caused by bowel obstruction. Also, due to known contrast allergy, IV contrast could not be administered which made it difficult to assess for active hemorrhage.
The patient remained clinically stable with slight anemia (Hb 70). Urgent MRI with contrast was performed which confirmed lack of active hemorrhage.