40 year old woman with abdominal pain and history of chronic renal failure

 

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Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation : Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree: Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Arezou Negahdari

 

Patient's Information

Gender : Female
Age : 40

 

Case Section

Cardiovascular

 

Clinical Summary

40 year old woman with abdominal pain and history of ESRD,that referred to our hospital .In another center ,surgery was done for her with left complex ovarian cyst diagnosis.

 

 

Imaging Procedures and Findings

contrast-enhanced CT reveals bilateral renal atrophy associated with interaperitoneal free fluid compatible with chronic renal failure. Superarenal abdominal aortic aneurysm with mural thrombosis is noted.(image1,2) Both Common iliac arteries and External iliac arteries have normal diameter.(image3,4) Axial CT at the level of pelvis shows leaking thrombosing left internal iliac artery aneurysm with soft tissue extending in to the pelvic region consistent with pelvic hematoma.(image5,6)

 

Discussion

As with the thoracic aorta, 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. DIFFERENTIAL DIAGNOSIS :Aortic Dissection True and false lumens separated by intimal flap Aorta can be of normal diameter Abdominal Aortic Trauma Normal or decreased aortic size and/or pseudoaneurysm Retroperitoneal hematoma or free peritoneal fluid Aortitis (Vasculitis) Aortic wall thickening; may have narrowing or aneurysms, wall enhancement with contrast Atypical age and risks for athero'sclerosis Etiologies include Takayasu, Behc;:etdisease, radiation

 

Final Diagnosis

AAA with left internal iliac artery (Look at the list of Differential Diagnosis)

 

References

Brant,WilliamE,Fundamentals of diagnostic radiology,3th edition.

 

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