Key result
Open surgical repair successfully treated a 57-year-old male presenting with a rare spontaneous aortocaval fistula complicated by paradoxical pulmonary embolism.
Case Report (n=1)
No
This case highlights the importance of prompt CT imaging to diagnose aortocaval fistula and associated paradoxical pulmonary embolism in patients with abdominal aortic aneurysm presenting with right heart overload.
Case of ACF with paradoxical embolism via CT warrants diagnostic vigilance in AAA; leaves open true incidence and management.
Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in less than 1% of all AAAs. Paradoxical embolism can rarely be associated with ACF, pulmonary embolism may originate from dislodgment of thrombotic material from the AAA in the inferior vena cava (IVC) through the ACF. We report a case of a patient admitted to the emergency department with abdominal pain and shortness of breath who immediately underwent thoraco-abdominal CT. Imaging allowed a prompt pre-operative diagnosis of an ACF between an AAA and the IVC, also identifying CT signs of right heart overload and the presence of a paradoxical pulmonary embolism.
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Vespro et al. (2021) conducted a case report in Spontaneous aortocaval fistula and paradoxical pulmonary embolism (n=1). Open surgical repair was evaluated. Open surgical repair successfully treated a 57-year-old male presenting with a rare spontaneous aortocaval fistula complicated by paradoxical pulmonary embolism.
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