Abstract

Abdominal aortic aneurysm and interventional stent placement

posted by Marco Das, M.D. | Apr 30, 2008

Case history
80-year-old male presented with suspicion of abdominal aortic aneurysm after a pulsating tumor was palpable in his abdomen during a routine examination.

Question
To exclude a malignant tumor in the abdomen and to evaluate a potential aortic aneurysm.

Diagnosis / Differential diagnosis
The first differential diagnosis of a pulsating tumor includes abdominal aortic aneurysms. This can be a true aneurysm or a false aneurysm, which often occurs after intervention (e.g. coronary intervention). Secondly, an intraabdominal tumor must be excluded. Acute bleeding must be ruled out as well.

Findings
An abdominal aortic aneurysm was found originating caudal of the renal arteries, extending to the common iliac arteries. The maximum axial aortic diameter was 6 cm, and the cranio-caudal extent was 9 cm. As no relevant additional diagnosis could be found, this patient was referred to interventional aortic stent placement.

Comment
With optimal bolus timing, a high quality CT Angiography of the abdominal aorta was achieved. The use of MPRs allowed optimal stent planning. Stent placement showed optimal results eliminating the aneurysm. DSCT was utilized for direct visualization of the aortic aneurysm.

[1] CT of the aorta shows infrarenal abdominal aneurysm. As the size of the aneurysm includes potential rupture, interventional stent placement was planned using MPRs.	[2] Angiography shows excellent stent position where the aneurysm could be excluded.
[3] 3D view of the prosthesis shows excellent result with full exclusion of the aneurysm and no signs of endoleakage.	[4] With automated bone removal, even better visualization of the aorta can be achieved, showing optimal stent positioning after EVAR.