Perforated saccular abdominal aortic aneurysm

Case contributed by Dr Foroogh Jafari Mousavi

Presentation

85 year old female with abdominal pain and distension ? bowel obstruction. Patient is allergic to contrast.

Patient Data

Age: 85
Gender: Female

1. Saccular aortic aneurysm arising from the abdominal aorta near the bifurcation.

2. A large retroperitoneal hematoma at the left side of the pelvic side wall 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.  

3. Other findings :

The right kidney is mildly atrophic, the left is markedly atrophic with a mild left hydronephrosis and hydroureter. Left adrenal gland demonstrates a nodule.

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 crescenteric cap of mural thrombus due to recent hemorrhage. The left retroperitoneal pelvic side wall hematoma is again demonstrated. There is no contrast extravasation from the aneurysm to suggest an 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.

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Case information

rID: 39771
Published: 10th Oct 2015
Last edited: 14th Aug 2019
System: Vascular
Inclusion in quiz mode: Included

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