PMC10467229_01
CT scan (a) showing significant biliary ductal dilation. (b) Demonstrating abdominal aortic aneurysm with separated left iliac stent consistent with a Type III endoleak.
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A CT scan of the abdomen and pelvis with intravenous contrast was completed confirming the sonographic findings as displayed in Figure 1(a). A large Type III endoleak of her aorto-iliac endograft secondary to a complete disconnect of the left iliac limb was also discovered, with a maximum aortic sac diameter of 6.1 x 6.0 cm as shown in Figure 1(b).
ERCP, imaging of common bile duct; consistent with a distal stricture.. ERCP: endoscopic retrograde cholangiopancreatography.
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The ERCP revealed a distal CBD stricture measuring 3 mm in length located 2 cm above the ampullary orifice with cystic dilation suggesting a Type III choledochal cyst demonstrated in Figure 2.
(a) Aortography demonstrating the Type III endoleak by showing contrast going into the aneurysm sac. (b) Completion aortogram showing preservation of renal arteries and no endoleaks.
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Next, the vascular surgical team performed an aortography via access from the right femoral artery which demonstrated extravasation of contrast into the aneurysm sac, as can be seen in Figure 3(a). A complete aortography was performed that revealed satisfactory placement with visualization of the renal arteries, complete exclusion of the aortic sac, and no endoleaks, as shown in Figure 3(b).