High output cardiac failure and paradoxical pulmonary emboli secondary to aortocaval fistula

We present images of a rare, potentially fatal but treatable complication of abdominal aortic aneurysms (AAAs).

An 81-year-old man was admitted with breathlessness on mild exertion, leg swelling and a 2 week history of back pain. He had florid signs of biventricular failure and a pulsatile mass in the abdomen. There was evidence of mild renal impairment. A transthoracic echocardiography revealed global hypokinesia and dilatation of the left and right ventricle. In addition, there was tricuspid regurgitation, a dilated right atrium and evidence of moderate pulmonary hypertension. A contrast enhanced CT scan revealed a large infra-renal AAA measuring 10.3 cm and 12 cm in antero-posterior and coronal diameters respectively (figures 1 and 2). There was marked intramural thrombus formation with an extension of the aneurysm into the proximal common iliac arteries and a focal right internal iliac artery aneurysm was noted. The presence of an aortocaval fistula was...

Source: http://pmj.bmj.com/cgi/content/short/88/1044/613?rss=1

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