Purpose
To demonstrate our experience in diagnosis of spontaneous aorto-caval fistula with abdominal CT after intravenous contrast enhancement.
Methods and Materials
In a six year period (January 2003-January 2008) we have performed 195 CT-scans for emergency evaluation of abdominal aortic aneurysms. Only two of them had developed aorto-caval fistula.These two cases presented in the emergency room of our hospital with complaints of abdominal pain, lower extremities edema and high levels of urea and creatinine. One of them had a known aneurysm of abdominal aorta.
Results
In both cases the following abdominal CT scan with i.v. contrast enhancement showed the aneurysm, the position of the aorto-caval fistula right before the aortic bifurcation, as well as the early enhancement of the inferior vena cava. In one of them the CT showed delayed opacification of the femoral artery and delayed renal cortex enhancement.The patients had been undergone a DSA of aorta and lower extremities and were treated by placing stents in aorta and external iliac arteries.In case 1, a week after the placement...
Conclusion
The quick diagnosis is very important because prompt surgical treatment is critical and contributes to decreased morbidity and mortality. CT scan is the less invasive, more safe method comparing DSA in diagnosis aorto-caval fistula(1-5). Magnetic resonance angiography with suppression of the venous signal can also identify an aorto-caval fistula but is a more complicated procedure with a significant number of limitations (6-8).
References
1. Salerno S, Romano I, De Luca T, Lo Casto A. MDCT and virtual angioscopy in spontaneous aorto-caval fistula. Int J Cardiovasc Imaging 2007;23:635-82. Sheward SE, Spencer RR,Hinton TR, Hightower CW, Patel PV, Suckarieh JG. Computed tomography of primary aortocaval fistula. Comput Med Imaging Graph 1992;16:121-1243.Davidovic LB, Kostic DM, Cvetkovic SD, Jakovljevic NS, Stojanov PL, Kacar AS et al. Aortocaval fistulas. Cardiovasc Surg 2002;10:555-5604. Koslin DB, Kenney PJ, Stanley RJ, Van Dyke JA. Aortocaval fistula: CT appearance with angiographic correlation. J Comput Assist Tomogr 1987;11:344-3505....
Personal Information
Dr. Mylona Sofia MDRed-Cross Hospital - Korgialenio - Benakio1 Athanasaki Str, Athens,
[email protected] Aikaterini MDRed-Cross Hospital - Korgialenio - Benakio1 Athanasaki Str, Athens,
[email protected] Agapi - Alexandra MDRed-Cross Hospital - Korgialenio - Benakio1 Athanasaki Str, Athens,
[email protected] Georgios MDRed-Cross Hospital - Korgialenio - Benakio1 Athanasaki Str, Athens,
[email protected]. Batakis NikolaosDirector of Radiology DepartementRed-Cross Hospital - Korgialenio - Benakio1 Athanasaki Str, Athens, Greece