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Il Giornale Italiano di Radiologia Medica 2018 Settembre-Ottobre;5(5):680-3

DOI: 10.23736/S2283-8376.18.00116-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Periprosthetic hyperattenuation at computed tomography after successful abdominal aortic aneurysm endovascular repair for impending rupture: something to worry about?

Elena BELLONI 1 , Federico PALTENGHI 1, David COSSARD 2, Antonio BATTAGLIA 2, Giovanni AMBROSINO 2

1 U.O.C. Radiodiagnostica Lomellina, Ospedale Civile di Vigevano, Azienda Socio-Sanitaria Territoriale (ASST) di Pavia, Pavia, Italia; 2 U.O.S.D. Chirurgia Generale a Indirizzo Vascolare, Ospedale Civile di Vigevano, Azienda Socio-Sanitaria Territoriale (ASST) di Pavia, Pavia, Italia


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Aortic true aneurysm is an abnormal dilatation of the vessel characterized by dilatation of all three vessel layers. The most frequent cause of true aneurysm is atherosclerosis. Aortic dilatation can develop in any segment, but the most frequent affected site is below the renal arteries. Aneurysms tend to increase in size over time and one of the complications can be rupture. Prompt diagnosis of impending abdominal aortic aneurysm rupture is implemented with computed tomography (CT). This is essential for proper treatment, which is performed, whenever possible, by means of endovascular aortic repair (EVAR), a less invasive procedure than open repair. Computed Tomography is then repeated at follow-up after prosthetic placement, to exclude complications such as leaks. We present the case of an 84-year-old male patient in whom CT performed 7 days after EVAR revealed increased thrombus hyperdensity at unenhanced scan, in comparison to the less extended hyperdensity seen in the CT before intervention, but in complete absence of signs and symptoms of complications. This finding was worrisome at first glance, however we concluded that increased hyperdensity was due to prior double iodinated contrast medium administration (during the first CT and subsequently in the aortography during the EVAR procedure) and not to increased hemorrhagic component in the excluded aneurysm sac. This case highlights that the radiologist should have an accurate knowledge of the clinical and radiological history of a patient, in order to correctly understand and report the CT findings after successful abdominal aortic aneurysm endovascular repair.


KEY WORDS: Aortic aneurysm, abdominal - Rupture - Tomography, X-ray computed - Complications

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