Case 9: Mycotic Pseudoaneurysm of the Abdominal Aorta in Association with Mycobacterial Psoas Abscess—A Complication of BCG Therapy1
Jeanne M. LaBerge, MD,
Robert K. Kerlan, Jr, MD,
Linda M. Reilly, MD and
Timothy A. Chuter, MD
1 From the Departments of Radiology (J.M.L., R.K.K.) and Surgery (L.M.R., T.A.C.), University of California San Francisco, Box 0628, 505 Parnassus Ave, San Francisco, CA 94143-0628. Received April 23, 1998; revision requested June 8; revision received July 7; accepted July 31. Address reprint requests to J.M.L.
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Figure 1a. Contrast-enhanced abdominal CT scans. (a) Axial image obtained through the proximal stent-graft shows a focal extraluminal contrast material collection (solid arrow) extending posterolaterally beyond the anticipated confines of and in continuity with the stent-graft and a low-attenuation mass (open arrow) in the left psoas muscle. (b) Axial image obtained through the midportion of the stent-graft. No contrast material leaks into the aneurysm, but a large, complex, rim-enhancing, low-attenuation mass (arrows) is seen within the psoas muscles bilaterally. The L4 vertebra is disrupted. (c) Axial image obtained through the lower abdominal aorta reveals a low-attenuation rim-enhancing mass (arrow) in the right iliac muscle.
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Figure 1b. Contrast-enhanced abdominal CT scans. (a) Axial image obtained through the proximal stent-graft shows a focal extraluminal contrast material collection (solid arrow) extending posterolaterally beyond the anticipated confines of and in continuity with the stent-graft and a low-attenuation mass (open arrow) in the left psoas muscle. (b) Axial image obtained through the midportion of the stent-graft. No contrast material leaks into the aneurysm, but a large, complex, rim-enhancing, low-attenuation mass (arrows) is seen within the psoas muscles bilaterally. The L4 vertebra is disrupted. (c) Axial image obtained through the lower abdominal aorta reveals a low-attenuation rim-enhancing mass (arrow) in the right iliac muscle.
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Figure 1c. Contrast-enhanced abdominal CT scans. (a) Axial image obtained through the proximal stent-graft shows a focal extraluminal contrast material collection (solid arrow) extending posterolaterally beyond the anticipated confines of and in continuity with the stent-graft and a low-attenuation mass (open arrow) in the left psoas muscle. (b) Axial image obtained through the midportion of the stent-graft. No contrast material leaks into the aneurysm, but a large, complex, rim-enhancing, low-attenuation mass (arrows) is seen within the psoas muscles bilaterally. The L4 vertebra is disrupted. (c) Axial image obtained through the lower abdominal aorta reveals a low-attenuation rim-enhancing mass (arrow) in the right iliac muscle.
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Figure 2a. Reformatted images from the same CT study shown in Figure 1. (a) Coronal reconstruction image through the retroperitoneum illustrates the extensive bilateral psoas and right iliac muscle involvement. Bone destruction of L4 and the L3 to L4 interspace (arrow) is also clearly demonstrated. (b) Maximum intensity projection CT angiogram shows the two Z-stents in the aortic portion of the stent-graft and a Wallstent extending into the left iliac artery. The upper part of a femoral-femoral crossover graft (arrowhead) is also visible. A saccular aneurysm at the top of the stent-graft (solid arrow) displaces the left renal artery (open arrow) superiorly.
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Figure 2b. Reformatted images from the same CT study shown in Figure 1. (a) Coronal reconstruction image through the retroperitoneum illustrates the extensive bilateral psoas and right iliac muscle involvement. Bone destruction of L4 and the L3 to L4 interspace (arrow) is also clearly demonstrated. (b) Maximum intensity projection CT angiogram shows the two Z-stents in the aortic portion of the stent-graft and a Wallstent extending into the left iliac artery. The upper part of a femoral-femoral crossover graft (arrowhead) is also visible. A saccular aneurysm at the top of the stent-graft (solid arrow) displaces the left renal artery (open arrow) superiorly.
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Figure 3a. Abdominal aortograms. (a) Image obtained in the early arterial phase shows a focal saccular aneurysm (solid arrow) adjacent to the proximal end of the stent-graft. Note the displacement of the left renal artery (open arrow) and a proximal left renal arterial stenosis. (b) Image obtained in the late arterial phase with opacification of the middle and distal portions of the graft. The stent-graft has Z-stents proximally within the aorta and distally within the iliac artery. A Wallstent has been deployed within the graft and extends through the distal iliac limb. An endovascular occluder is visible in the right common iliac artery.
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Figure 3b. Abdominal aortograms. (a) Image obtained in the early arterial phase shows a focal saccular aneurysm (solid arrow) adjacent to the proximal end of the stent-graft. Note the displacement of the left renal artery (open arrow) and a proximal left renal arterial stenosis. (b) Image obtained in the late arterial phase with opacification of the middle and distal portions of the graft. The stent-graft has Z-stents proximally within the aorta and distally within the iliac artery. A Wallstent has been deployed within the graft and extends through the distal iliac limb. An endovascular occluder is visible in the right common iliac artery.
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Copyright © 1999 by the Radiological Society of North America.
