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Case of the Month

June 2013

Patient Data: Female patient 56 year old

Clinical Info: Patient was referred for an ultrasound examination to exclude a urolithiasis because of pain in her back

Longitudinal image of the right kidney with a mass impressing the lowerpole

Another longitudinal image of the right kidney. The mass is inhomogeneous

Transverse image of the same mass impressing the right kidney

The mass displaces the vena cava anteriorly

The mass is dorsal to the renal vessels and not vascularized. Can you guess what it is

Transverse image of the aorta showing an aneurysm

Transverse image showing the hematoma arising from the aneurysm.The patient had a ruptured abdominal aneurysm with a large retroperitoneal hematoma impressing the kidney

Not all patients are just as lucky as in the previuos case. This was a similar looking image of a comatous patient of over 80 years old

This hematoma is also inhomogeneous and there is a perirenal effusion

In this case there is also a ruptured abdominal aortic aneurysm

Transvere image of the aneurysm. The patient died immediately after the ultrasound examination

Although many patients with a ruptured abdominal aneurysm present with classical clininical symptoms including hypotension the clinical presentation can be less classical and one should always be aware of this possibility. A retroperitoneal hematoma with an aortic aneurysm is always suspicious for a leaking or ruptured aortic aneurysm.

For more cases of ruptured and non ruptured aortic aneurysms see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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