PMC6837780_01
Axial contrast-enhanced computed tomography showing a large infrarenal aneurysm (star) having a fistulous communication (white diagonal arrow) on its right posterolateral wall with inferior vena cava (black arrow).
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F0001
AAA with a partially thrombosed periphery. Active extra luminal extravasation of contrast was seen from the right lateral wall, into the peritoneal cavity (Figures 1 and 3a). There was a fistulous communication on the right posterolateral wall of aorta with the inferior vena cava (IVC), with a flap displaced into the IVC about 4.5 cm distal to the origin of the renal arteries (Figure 1).
Axial contrast-enhanced computed tomography scan during the arterial phase showing opacification of the common iliac arteries and veins bilaterally, with similar attenuation (white arrows); layering of contrast was observed in the iliac veins (black arrow).
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F0002
The lower abdominal IVC and iliac veins were opacified on the arterial phase with contrast medium density similar to that of the aorta (HU 350) (Figure 2).
(a) Axial contrast-enhanced computed tomography scan demonstrating active extravasation of contrast into the peritoneal cavity (arrow). Contrast is also seen in the renal veins; (b) Contrast seen in the hepatic inferior vena cava (arrow) but with less attenuation (HU - 150) owing to reflux from right atrium.
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F0003
AAA with a partially thrombosed periphery. Active extra luminal extravasation of contrast was seen from the right lateral wall, into the peritoneal cavity (Figures 1 and 3a). This helped in excluding reflux of contrast from the right atrium as the cause for opacification in the lower abdominal IVC (Figure 3b).