Author: Sebastian Leschka, MD
Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland

History

An 81-year-old male patient presented at the radiology department for follow-up examination. Six weeks before the patient had been delivered to the hospital for coiling and stent implantation because of a ruptured aneurysm of arteria iliaca interna. Previous to implantation, the patient complained over pain in the lower abdominal region. One day after stent implantation a type II endoleakage appeared. Four days after implantation, an acute bleeding of the urethra had been found after removal of permanent catheter.
The scheduled follow-up exam was requested to indicate progress of convalescence.

Diagnosis

During examination with SOMATOM Definition Flash scanner, supra-aortic vessels were shown to be normal. No pathologically increased lymph nodes could be found. There were no findings regarding pleural contusion or pneumothorax. Moderately decreased dorso-basal left-sided lung-ventilation was noted but no pathological pulmonary or mediastinal lesions could be detected.
The abdomen was found to be adequately perfused and the previously coiled right arteria iliaca interna was retrogradely supplied with blood. In the right-sided pelvis minor, the known Iliaca interna aneurysm, a non-perfused sack-like aneurysm with maximum dimension of 6.9 cm X 7.2 cm, was visible. Additionally, an arising, cyst-like hematoma (max. 6.4 cm X 3.3 cm) was detected. The boundary area of the hematoma showed increased contrast media uptake. The implanted stent in the right arteria iliaca communis showed a regular position not indicating any endoleak. No intraperitoneal fluid was visible. No pathologically increased lymph nodes were found in the abdomen.

Comments

The follow-up could be conducted quickly and progress of the patient´s convalescence indicated with reliable image results. Regular follow-up investigations for monitoring future recovery have been recommended.
For the scan, only a dose of 3.01 mSv was necessary. With the very same single scan, substantial coronary artery stenosis could be excluded.

<sup>The information presented in this case study is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard.

The drugs and doses mentioned herein are consistent with the approval labelling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating the CT System. The source for the technical data is the corresponding data sheets. Results may vary.</sup>