Emphysematous Abdominal Aortitis

Gündoğdu, Elif; Kırmızıgül, Hilal; Demir, Serhat

doi:10.1590/0037-8682-0595-2023

A 71-year-old male patient presented to the emergency department with complaints of lower left quadrant and back pain, chills, shivering, and nausea persisting for the past two days. The patient's medical history included diabetes mellitus, coronary artery disease, and vascular intervention for aortoiliac graft placement two months ago. His body temperature was 39 °C. Laboratory tests revealed leukocytosis (13.5x103 uL) and, elevated C-reactive protein (72 mg/L) and procalcitonin (95.31 ng/mL) levels. Empirical antibiotic therapy was initiated and subsequent testing revealed a Salmonella typhi H antigen titer of 1/160. A computed tomography (CT) scan demonstrated occlusion of the left iliac artery and distal abdominal aorta stent, aortic wall thickening, perivascular fat stranding, vessel wall gas formation, and several lymph nodes (Figure 1). The patient was diagnosed with emphysematous aortitis, a rare yet life-threatening condition caused by gas-forming organisms¹1. Li Z, Zhang H, Yu L. Emphysematous Aortitis of the Abdominal Aorta. Radiol Cardiothorac Imaging. 2023;5(1):e220192.. The risk factors for emphysematous aortitis include atherosclerotic disease, preexisting aneurysms, diabetes mellitus, and other immunocompromised states²2. Md Noh MSF, Abdul Rashid AM, Ar A, B N, Mohammed Y, A R E. Emphysematous aortitis: report of two cases and CT imaging findings. BJR Case Rep. 2017;3(3):20170006.. Most reported cases of emphysematous aortitis are associated with complications of endovascular graft procedures, similar to the case presented here³3. Harris C, Geffen J, Rizg K, Shah S, Richardson A, Baldeo C, et al. A Rare Report of Infectious Emphysematous Aortitis Secondary to Clostridium septicum without Prior Vascular Intervention. Case Rep Vasc Med. 2017;2017:4984325.. Because patients often present with nonspecific symptoms, imaging plays a crucial role in achieving an accurate diagnosis²2. Md Noh MSF, Abdul Rashid AM, Ar A, B N, Mohammed Y, A R E. Emphysematous aortitis: report of two cases and CT imaging findings. BJR Case Rep. 2017;3(3):20170006.. Therefore, CT could be a rapid and reliable diagnostic tool in such a case.

FIGURE 1:
Axial (A) and coronal (B) plane abdomen CT shows occlusion of the distal abdominal aorta, perivascular fat stranding (blue arrows), vessel wall gas formation (yellow arrows), and several lymph nodes (red arrow).

ACKNOWLEDGMENTS

The authors of the manuscript have no acknowledgments.

REFERENCES

¹
Li Z, Zhang H, Yu L. Emphysematous Aortitis of the Abdominal Aorta. Radiol Cardiothorac Imaging. 2023;5(1):e220192.
²
Md Noh MSF, Abdul Rashid AM, Ar A, B N, Mohammed Y, A R E. Emphysematous aortitis: report of two cases and CT imaging findings. BJR Case Rep. 2017;3(3):20170006.
³
Harris C, Geffen J, Rizg K, Shah S, Richardson A, Baldeo C, et al. A Rare Report of Infectious Emphysematous Aortitis Secondary to Clostridium septicum without Prior Vascular Intervention. Case Rep Vasc Med. 2017;2017:4984325.

Financial Support: No funding was received for this study.

Publication Dates

Publication in this collection
05 Feb 2024
Date of issue
2024

History

Received
09 Dec 2023
Accepted
29 Dec 2023

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Li Z, Zhang H, Yu L. Emphysematous Aortitis of the Abdominal Aorta. Radiol Cardiothorac Imaging. 2023;5(1):e220192.

[2] ²
Md Noh MSF, Abdul Rashid AM, Ar A, B N, Mohammed Y, A R E. Emphysematous aortitis: report of two cases and CT imaging findings. BJR Case Rep. 2017;3(3):20170006.

[3] ³
Harris C, Geffen J, Rizg K, Shah S, Richardson A, Baldeo C, et al. A Rare Report of Infectious Emphysematous Aortitis Secondary to Clostridium septicum without Prior Vascular Intervention. Case Rep Vasc Med. 2017;2017:4984325.

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