CT Case 084
An 88-year-old man presents with right lower abdominal and back pain, with radiation into his right leg.
He has a previous history of abdominal aortic aneurysm (AAA) with Endovascular Aortic Aneurysm Repair (EVAR) in 2010, which has been complicated by several endoleaks requiring repair.
While awaiting CT scan he becomes incredibly hypotensive and CT is expedited
Describe and interpret the CT scan
Clinical Pearls
Endovascular aneurysm repair (EVAR) is now a viable minimally invasive alternate option for repair of AAAs in select patient groups. However, they may be complicated by a higher long-term risk of rupture and need for further intervention. This is primarily due to endoleaks which may occur in up to 25% of patients, resulting in aneurysm expansion and rupture.
As discussed in CT Case 42, when a AAA does rupture it carries an incredibly high mortality rate of 80% (100% mortality if managed non-operatively).
Given the extensive previous surgical repair, the vascular team deemed there were no rescue options and this patient was managed with comfort cares, he passed away soon after.
References
- White SB, Stavropoulos SW. Management of Endoleaks following Endovascular Aneurysm Repair. Semin Intervent Radiol. 2009 Mar;26(1):33-8.
- Lam L. CT Case 042. LITFL
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Dr Leon Lam FRANZCR MBBS BSci(Med). Clinical Radiologist and Senior Staff Specialist at Liverpool Hospital, Sydney
Sydney-based Emergency Physician (MBBS, FACEM) working at Liverpool Hospital. Passionate about education, trainees and travel. Special interests include radiology, orthopaedics and trauma. Creator of the Sydney Emergency XRay interpretation day (SEXI).
Provisional fellow in emergency radiology, Liverpool hospital, Sydney. Other areas of interest include paediatric and cardiac imaging.
Emergency Medicine Education Fellow at Liverpool Hospital NSW. MBBS (Hons) Monash University. Interests in indigenous health and medical education. When not in the emergency department, can most likely be found running up some mountain training for the next ultramarathon.