Presentation
History of atrial fibrillation on apixaban. Syncopal event at nursing care facility.
Patient Data
There is a large penetrating atherosclerotic ulcer just distal to left subclavian artery at the arch with a markedly lobulated contour. There are other smaller penetrating ulcers along the superior medial aspect of the distal aortic arch. There is moderate calcified atherosclerotic plaque at aortic arch and of the descending thoracic aorta.
There is aneurysmal dilatation of the abdominal aorta. There is a large amount of high density fluid within the retroperitoneal space extending inferiorly into the pelvis. There is a large amount of active extravasation as identified on the delayed phase study.
There is high-grade stenosis at the origin of the celiac artery with short segment occlusion/high-grade stenosis with distal reconstitution.
Severe flattening of IVC and renal veins, suggestive of severe hypovolemia.
Case Discussion
This is a case of abdominal aortic rupture with evidence of active extravasation of contrast (compatible with active hemorrhage) into the peritoneal cavity. Following the CT, the patient became increasingly hypotensive and pale. The patient's family sought comfort measures.
Co-author:
Christine Cooley, MD
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