Demographics:
77 years old, Male
Indication:
Hematochezia
Findings
Chest
- Endotracheal tube terminates above the carina
- Dependent bilateral lower lobe groundglass opacities
- Scattered pulmonary nodules measuring up to 6 mm in the right upper lobe and 5 mm in the right middle lobe
- Four chamber cardiomegaly
- Post CABG changes
- Heavy coronary artery calcification
- Aortic valve and mitral annular calcification
- Thoracic aortic atherosclerosis without aneurysm
Abdomen/Pelvis
- Abdominal aortic aneurysm measuring 5.3 x 3.8 cm in maximal transaxial dimensions with a craniocaudal span from the origin of the left renal artery to the aortic bifurcation
- Loss of the normal fat planes between the aneurysm and the third segment of the duodenum with a small fistula extending from the aorta to the junction of the third and fourth duodenal segments and contrast density material layering in the distal duodenum
- Periaortic soft tissue stranding with a likely additional site of contrast extravasation noted posteriorly in the more inferior infrarenal abdominal aorta
- Surgical changes of aortobifemoral bypass with likely chronic occlusion of the native distal abdominal aorta and iliac vessels
- Both common femoral arteries opacify via retrograde flow, with retrograde opacification also extending into the external and internal iliac arteries on the left
- Narrowing at the origin of the celiac artery with poststenotic dilation
- Gastric suction tube tip in the duodenal bulb
- Bilateral renal atrophy and multifocal cortical scarring
- Mild nonspecific mesenteric and perinephric fat stranding
- Urinary bladder is decompressed around a Foley catheter
MSK
- No acute findings
- Polyarticular degenerative changes
- Midline laparotomy scar
Diagnosis
Aortoenteric fistula
Sample Report
Aortoenteric fistula from the infrarenal abdominal aorta to the distal duodenum with active contrast extravasation into the duodenal lumen. Recommend emergent surgical evaluation.
5.3 cm abdominal aortic aneurysm with periaortic stranding and an additional site of contrast extravasation more inferiorly along the posterior margin consistent with aneurysm leak.
Surgical changes of aortobifemoral bypass with patent grafts.
Bilateral dependent groundglass pulmonary opacities which may relate to atelectasis and/or aspiration.
Multiple pulmonary nodules measuring up to 6 mm. Recommend follow-up chest CT in 12 months if there is no prior imaging available to document stability.
Discussion