Presentation
Abdominal pain and distension
Patient Data
Age: 82
Gender: Male
From the case:
Aortic graft infection
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Oral contrast enhanced study.
Findings:
- Abdominal aortic aneurysm with a maximal diametre of 47mm. Aorto bi-femoral stent noted in the infra-renal abdominal aorta.
- Eccentric soft tissue density in the anterolateral aspect of the terminal abdominal aorta measuring 20 mm in axial thickenss.
- Stranding of the retro-peritoneal fat planes.
- Multiple prominent para-aortic lymphnodes.
Other findings:
- Further aneurysm involving the left external illiac artery.
- Small saccular aneurysm in the proximal left common illiac artery.
- Large right sided pleural effusion.
- Calcified bilateral pleural plaque.
- Borderline cardiomegaly.
- Pacing wires within the heart.
- Scattered free fluid within the peritoneum.
- Bilateral renal atrophy
- Bilateral psoas major muscle atrophy.
Findings are consistent with an infected aorto-bifemoral stent.
Case Discussion
Peri-graft infections are a well recognized complication of endovascular abdominal aortic aneurysm repair. This patient was found to have positive Listeria blood cultures. Patient's CRP was elevated.
Soft tissue stranding around the aorta is suggestive of inflammation. The soft tissue densities are not circumferential or symmetrical. Moderate stranding of the retroperitoneal fat planes and prominent lymph nodes help to secure the diagnosis.
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