Case 15 from Drew Sullivan
[az_accordion_section] [accordion title=”History” id=”acc-1″]50 year old male with a one month history of intermittent fevers and night sweats with back pain.
Background history of open AAA repair and treated Hodgkin’s lymphoma which is now in remission.
Review the CT Abdomen and identify the responsible pathology for this patient’s symptoms.[/accordion] [accordion title=”Image” id=”acc-2″]
[/accordion] [accordion title=”Answer” id=”acc-3″]This CT Abdomen with intravenous contrast in the arterial phase demonstrates stigmata of aortitis secondary to the development of an aortoenteric fistula. Gas is present in the remnant aneurysm sac following the previous abdominal aortic aneurysm repair. There is associated retroperitoneal lymphadenopathy around the aorta and the process is adherent to the third part of the duodenum, which is presumably the source of gas. This implies that a fistulous connection has developed. Catastrophic haemorrhage into the duodenum is possible.
Incidental finding of a contracted gallbladder containing multiple gallstones, consistent with chronic cholecystitis.[/accordion] [/az_accordion_section]