Abstract
Supplemental material is available for this article.
Keywords: CT Angiography, Vascular, Aorta, Aneurysms, Infection
A 79-year-old man presented with abdominal pain and mild fever for 3 days. The patient’s vital signs were stable, and he had a previous history of diabetes mellitus and autoimmune pancreatitis. Abdominal CT revealed severe atherosclerosis of the abdominal aorta and an aneurysm in the left posterior lateral wall. The aneurysm was surrounded by inflammatory exudate with gas formation (Fig A), which are findings suggestive of emphysematous aortitis. The patient began treatment with broad-spectrum antibiotics (biapenem and tinidazole), and his body temperature gradually returned to normal. Two days later, CT angiography of the abdominal aorta showed substantial enlargement of the aneurysm (Fig B–D, Movies 1 and 2). Due to risk of aneurysm rupture, the patient underwent endovascular stent placement (Fig E), and a drainage tube was placed next to the abdominal aorta. The first discharge was 8 mL of dark red drainage fluid, and a bacterial culture grew Klebsiella pneumoniae. After antibiotic treatment, re-examination CT imaging showed reduction in inflammatory exudate and resolution of the surrounding gas (Fig F, Movie 3). Antibiotic treatment was continued, and the patient was discharged in stable condition.
Images in a 79-year-old man diagnosed with emphysematous aortitis. (A) Axial abdominal CT scan on the day of presentation shows extensive atherosclerosis of the abdominal aorta with an aneurysm (approximately 6 × 6 mm) in the left posterior lateral wall (arrow) surrounded by a collection of gas (*). (B–D) Repeat CT obtained 2 days after admission shows rapid expansion of the pseudoaneurysm (arrow) with an increase in the amount of gas within the periaortic soft tissue (*), posing a risk of rupture. (E) Endovascular stent placement was indicated for treatment of expanding pseudoaneurysm. (F) Axial abdominal CT 3 months after surgery shows resolution of the surrounding gas (*).
Movie 1:
Axial CT angiographic image of the abdominal aorta. Extensive atherosclerosis of the abdominal aorta and an aneurysm in the left posterior lateral wall, surrounded by a collection of gas.
Movie 2:
Volume-rendered CT angiographic image shows three-dimensional views of the abdominal aortic aneurysm and surrounding gas.
Movie 3:
Axial abdominal CT images were reviewed 3 months after surgery and show near absence of the surrounding gas.
Emphysematous aortitis is a rare but severe disease that manifests through the presence of air within or surrounding the inflamed aorta. Infection is typically caused by bacteria that produce gas. A compromised immune system due to diabetes or cancer may be a risk factor (1,2).
Footnotes
Authors declared no funding for this work.
Disclosures of conflicts of interest: Z.L. No relevant relationships. H.Z. No relevant relationships. L.Y. No relevant relationships.
Keywords: CT Angiography, Vascular, Aorta, Aneurysms, Infection
References
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