Radiology Presentation Adam Juersivich

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Radiology PresentationAdam Juersivich

• 66 yo male with BRBPR

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• 66 yo man with hx of pandiverticulitis presents
  to ER following fall in hot tub with complaint of
  back pain. Noted to have blood in underwear.
  Denies N/V/D, fever, or chills. Endorses melena,
  crampy suprapubic pain for months, and RLE
  weakness. Abnormal WBC of 16, elevated RDW.
  Admitted to GI service with suspected
  diverticulosis. Two days later patient noted to
  have AMS and sent for Head and Abd/Pelvic CT.

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Diagnosis

• Bilateral internal iliac aneurysms
• Rupture of the right aneurysm sac with hemorrhage
  into the bowel wall likely secondary to
  diverticular disease

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Features

• Internal Iliac Artery Aneurysm (IIAA)?
• Radiographic
• Dilation of more than 50 of normal artery size
• lt3cm is considered small
• Curvilinear calcification of wall
• Rupture 33 not diagnosed until ruptured
• Frequency
• IIAAs are rare represent 1-2 of intraabdominal
  aneurysms
• Most often are an extension of an AAA
• Mortality
• 33-50 mortality during open surgical repair

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Outcome

• Vascular team performed angiography
  w/embolization of the right internal iliac artery
  immediately followed by a diverting colostomy.
  He went to TCV/PO and was weened from the vent.
  On Sept 7th he made it to the floor. He was
  discharged to a SNF on Sept 12th to have help
  with care of colostomy site.

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References

• B. van Kelckhoven, B.M.A. Bruijninckx, B.
  Knippenberg, and H. van Overhagen. Ruptured
  Internal Iliac Artery Aneurysm Staged Emergency
  Endovascular Treatment in the Interventional
  Radiology Suite. Cardiovasc Interventional
  Radiology. 2007 July 30(4) 774777.
• L. dé Medici, F. Bucci, F. Nesi and G. Rabitti.
  Embolization of Isolated Hypogastric Artery
  Aneurysm A Case Report and a Review of the
  Literature. Cardiovasc and Interventional
  Radiology. 2006 Oct. 29(5) 893-896.