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Sealed rupture of aortic aneurysm in an elderly patient with non-specific abdominal pain
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  1. Abhishek Mitra1,
  2. Harold Horsfall2,
  3. Ben Mercer,
  4. Siva Namasivayam1
  1. 1
    Calderdale and Huddersfield NHS Trust, Urology, Huddersfield Royal Infirmary, Acre Street, Lindley, Huddersfield HD3 3EA, UK
  2. 2
    Calderdale and Huddersfield NHS Trust, Radiology, Huddersfield Royal Infirmary, Acre Street, Lindley, Huddersfield HD3 3EA, UK
  1. Abhishek Mitra, docmitra{at}yahoo.com.au

https://doi.org/10.1136/bcr.08.2008.0701

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    DESCRIPTION

    CT images of a 86-year-old man who presented with a 24-hour history of right loin pain. Abdominal x rays revealed bilateral staghorn calculi and urine analysis suggested urinary tract infection. A CT scan of his abdomen, done under the renal protocol to visualise the urinary tract better, revealed the unexpected presence of a contained rupture of an abdominal aortic aneurysm.

    Figure 1
    Figure 1

    The retroperitoneal collection: the CT scan image shows heterogeneity in the retroperitoneum with density ranging from 17–37 Hounsfield Units, which is consistent with blood. The collection is contiguous with the right lateral margin of an aneurysmal infra-renal abdominal aorta, measuring 4.3×4.8 cm in its maximum transverse dimension. The spread of the blood has been indicated in colour in the middle image.

    Figure 2
    Figure 2

    Site of bleeding: at the level of L5, the rim of calcification within the wall of the aorta is seen dissecting from the vessel wall, which suggests it could be a possible site of bleeding.1

    LEARNING POINTS

    • Older patients often present with atypical signs and symptoms and concurrent pathologies.2

    • A common pitfall is to discontinue further investigations on obtaining initial investigative evidence in support of a provisional diagnosis.

    • Where available, cross-sectional imaging by CT is a high value, high yield, examination enabling the consideration of a broader range of pathologies.

    • We recommend a low threshold for CT scanning in elderly patients with confusing abdominal symptoms. An ultrasound scan would be an alternative to exclude major pathologies.

    REFERENCES

    1. ↵
      1. Ando M,
      2. Igari T,
      3. Yokoyama H,
      4. et al
      . CT features of chronic contained rupture of an abdominal aortic aneurysm. Ann Thorac Cardiovasc Surg 2003; 9: 4.
      OpenUrl
    2. ↵
      1. Ahmad N,
      2. Ather M,
      3. Rees J
      . Incidental diagnosis of diseases on un-enhanced helical computed tomography performed on ureteric colic. BMC Urology 2003; 3: 2.
      OpenUrlCrossRefPubMed

    Footnotes

    • Competing interests: none.

    • Patient consent: Patient/guardian consent was obtained for publication.