Abstract
Aortocaval fistula (ACF) is a rare, life threatening complication of abdominal aortic aneurysms. Time to diagnosis is crucial as preoperative diagnosis and early surgical intervention significantly improve the outcome. The clinical spectrum being varied, the challenge of prompt and reliable diagnosis rests on emergency radiology. While the gold standard for detecting ACF today is CT angiography (CTA), frequently complicating renal insufficiency discourages the use of iodinated contrast making MR angiography (MRA) a useful alternative. Contrast enhanced ultrasound (CEUS) provides a promising new diagnostic option allowing rapid, non invasive and bedside diagnosis, especially in hemodynamically unstable patients. We present a case of prompt diagnosis of ACF by CEUS in comparison to modern MRA, thus establishing the new potential role of CEUS.
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References
Davidovic LB, Kostic DM, Cvetkovic SD, Jakovljevic NS, Stojanov PL, Kacar AS et al. Aorto-caval fistulas. Cardiovasc Surg 2002;10:555–60.
Coulier B, Tilquin O, Etienne P-Y. Multidetector row CT diagnosis of Aortocaval fistula complicating aortic aneurysm: a case report. Emergency Radiology 2004;11:100–3.
Fenster MS, Dent JM, Tribble C, Angle JF, Sarembock IJ, Komada M et al. Aortocaval fistula complicating abdominal aortic aneurysm: case report and literature review. Cathet Cardiovasc Diagn 1996; 38:71–9.
Salerno S, Romano I, De Luca T, Lo Casto A. MDCT and virtual angioscopy in spontaneous aortocaval fistula. Int J Cardiovasc Imaging 2007; 23:635–38.
Clevert DA, Stickel M, Johnson T, Glaser C, Clevert DA, Steitz HO, Kopp R, Jauch KW, Reiser M. Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 2007;17: 2991–3000.
Greis C. Technology overview: SonoVue (Bracco, Milan). Eur Radiol 2004;14(Suppl 8):11–15.
Rosenthal D, Atkins CP, Jerrius HS, et al. Diagnosis of aortocaval fistula by computed tomography. Ann Vasc Surg 1998;12:86–7.
Gaa J, Böhm C, Richter A, Trede M, Georgi M. Aortocaval fistula complicating abdominal aortic aneurysm: diagnosis with gadolinium-enhanced threedimensional MR angiography. Eur. Radiol.1999; 9:1438–40.
Catalano O, Lobianco R, Cusati B, Siani A. Contrast-Enhanced Sonography For Diagnosis of Ruptured Abdominal Aortic Aneurysm. AJR 2005;184: 423–27.
Syme J (1831) Case of spontaneous varicose aneurysm. Edinb Med Surg J 36:1045.
Rajmohan B. Spontaneous aortocaval fistula. J Postgrad Med 2002; 48:203–5.
Clevert DA, Stickel M, Flach P, Strautz T, Horng A, Jauch KW, Reiser M. Contrast-Enhanced Ultrasound in Detection and Follow-Up of an Infrarenal Abdominal Aortic Aneurysm with Aorto-Caval Fistula and Endovascular Treatment. Cardiovasc Intervent Radiol 2007; 30:480–84.
Adam DJ, Bradbury AW, Stuart WP, et al. The value of computed tomography in the assessment of suspected ruptured abdominal aortic aneurysm. J Vasc Surg 1998; 27:431–37.
Barr R. Seeking consensus: contrast ultrasound in radiology. Eur J Radiol 2002; 41:207–16.
Jones PG, Peak S, McClelland A, Holden A, Higginson I, Gamble G. Emergency ultrasound credentialing for focused assessment sonography in trauma and abdominal aortic aneurysm: a practical approach in Australasia. Emerg Med (Fremantle) 2003;15: 54–62.
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Bhatia, M., Platon, A., Khabiri, E. et al. Contrast enhanced ultrasonography versus MR angiography in aortocaval fistula: case report. Abdom Imaging 35, 376–380 (2010). https://doi.org/10.1007/s00261-009-9507-x
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DOI: https://doi.org/10.1007/s00261-009-9507-x