Ruptured abdominal aortic aneurysm

Case contributed by Dr Michael Lousick

Presentation

Sudden onset of severe left lower quadrant pain and vomiting.

Patient Data

Age: 80 years
Gender: Female

Abdominal radiograph

X-ray

Nil evidence of bowel obstruction or pneumoperitoneum. There is a calcified abdominal aortic aneurysm.

CT abdomen

CT

There is a 6 cm infrarenal abdominal aortic aneurysm with a 3 cm mural thrombus. Large volume of retroperitoneal dense fluid abuts the anterolateral aorta, left renal fascia and left psoas muscle.

Findings consistent with a ruptured abdominal aortic aneurysm.

EVAR

Fluoroscopy

Successful endovascular aneurysm repair (EVAR)

Case Discussion

The presence of the AAA on the plain film radiograph demonstrates an important finding. In hindsight, the loss of the left psoas silhouette and overlying density representing the aortic bleeding can be appreciated.

A portal venous phase CT was completed as less sinister diagnoses were being considered at the time of imaging.

The patient went on to undergo successful endovascular aneurysm repair.

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