PMC5721207_01
Lymph node between inferior vena cava and aorta, a rind of inflammatory tissue, haziness posterior to the AAA.
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A computed tomography (CT) scan performed the following day demonstrated a mild left hydronephrosis and a 5.5 cm infrarenal AAA that had "worrying features" of a recent small leak (Fig. 1). An urgent referral was made to the vascular team, and on finding a tender aneurysm on abdominal examination, she underwent an emergency EVAR for her symptomatic non-ruptured infrarenal AAA. A further retrospective review of the first presentation CT by a vascular radiologist identified a lymph node between the inferior vena cava and the aorta, a rind of inflammatory tissue, swollen adventitia, and haziness posterior to the AAA and left common iliac artery suggestive, in retrospect, of a mycotic picture (Fig. 1).
Large abscess in left psoas and left hydronephrosis.
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CRP of 180 mg/L. CT imaging on this admission confirmed graft infection, enlargement, and rupture of the aneurysm sac with a multiloculated abscess extending into the left psoas muscle (Fig. 2).
Left nephrostogram showing no mechanical obstruction.
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Two days later a nephrostogram showed no evidence of mechanical obstruction (Fig. 3).