Prosthesis infection after surgical abdominal aortic prosthesis

Case history
68-year-old male with a history of surgical aortic repair after aortic rupture. Patient showed elevated infectious parameters.

Question
CT Angiography of the abdominal aorta was performed to rule out an intraabdominal focus or prosthesis infection.

Diagnosis / Differential diagnosis
First differential diagnosis in this patient would be an intraabdominal focus like abscess formation as pulmonary infection was ruled out earlier. Potential bleeding after surgery needs to be ruled out. In rare cases, prosthesis infection occurs. Additionally prosthesis insufficiency or endoleak need to be ruled out.

Findings
Fluid around the aortic prosthesis is found. The aortic wall shows significant enhancement and oedematous fluid in the surrounding fat, as a sign of infection. The patient underwent nephrectomy on the left side.

Comment
The use of MSCT/DSCT allows optimal visualization not only of the aorta itself like in DSA, but also allows visualization beyond the vessel wall. The use of multiplanar reformats offers visualization in any dimension with the same high image quality.

[1] Coronal MPR shows large fluid collection originating from the aorta.	[2] Axial image shows the large fluid collection and also shows fluid around the aorta and enhancement of the aortic vessel wall.
[3] Sagittal image shows fluid around the prosthesis in craniocaudal extent.	[4] 3D VRT delineates the aortic prosthesis. Due to the threshold settings, the fluid collection cannot be delineated.

Authors: Marco Das, Andreas H. Mahnken, Joachim E. Wildberger
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