PMC6159304_01
Pre-operative arterial phase (a, b and d) and venous phase (c) multidetector CT scans with 0.1 cm slices through the abdomen and pelvis. Axial images show the dissection arising in the infrarenal aorta (a) and extending across the aortic bifurcation (b) to the right internal iliac artery (c and d). Periaortic fat stranding indicates indolent infection and inflammation. Despite conservative management, persistence of inflammatory changes could be seen with an increase in the size of the right common iliac aneurysmal sac from 4.3 x 2.1 cm (c) to 5.0 x 2.8 cm (d) 6 days later. Such rapid aneurysmal dilatation seen in less than 1 week indicated that, if left untreated, the aneurysm was at risk of further expansion and rupture.
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fig1
The appearance was that of a mycotic aneurysm, with the walls of the aorta appearing inflamed with periaortic and peri-iliac fat stranding present (Figure 1).