79 years old man presenting

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Doctor's Information

Name :  Hussein
Family :Soleiman Tabar
Affiliation : ----------------
Academic Degree: ----------------
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Resident :  ----------------

Patient's Information

Gender : Male
Age : 79

Case Section

Cardiovascular

Clinical Summary

79 years old man presenting with abdominal mass and pain.

Imaging Procedures and Findings

A huge infrarenal aneurysm of abdominal aorta is seen with maximum diameter of 9 cm. Mural thrombosis and wall calcification are also noted. No evidence of leak is visible.

Discussion

There are multiple possible etiologies for abdominal aortic aneurysms, but two are of primary importance: atherosclerosis and infection. The most common etiology of abdominal aortic aneurysms (AAAs) is degenerative, which for the most part is synonymous with atherosclerotic. An atherosclerotic AAA is defined as enlargement of the aorta at least 1.5 times greater than the normal vessel diameter. Atherosclerotic AAAs are for the most part fusiform and often lined with mural thrombus. Although US does demonstrate the aneurysm, CT has become the diagnostic study of choice. Angiography is usually only indicated for a particular patient and their special situation. Angiography only demonstrates the true lumen, not the portion of the aneurysm, which is thrombus filled, and, of course, has a finite complication rate, as does any invasive procedure. Angiographically, an AAA is seen as an irregular, often calcified, fusiform aneurysm. Angiography does demonstrate the patency of the other major vessels (renals, visceral, iliacs), as well as their relationship to the AAA. Of greatest importance is the relationship of the renal arteries to the AAA, as it influences the surgical or endovascular repair. The indication for the elective repair of an asymptomatic AAA is when the diameter exceeds 5 cm. It is at this diameter that the chance of rupture increases dramatically. It is common for an AAA to extend into the iliac arteries, and 99% of atherosclerotic iliac artery aneurysms are associated with an AAA. Treatment of AAAs has been traditionally by open surgical repair. However, stent graft placement has become widely used because of its minimal invasiveness.

Final Diagnosis

Abdominal aortic aneurysm

References

Brant, William E.; Helms, Clyde A. Fundamentals of Diagnostic Radiology, 3rd Edition