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High output cardiac failure and paradoxical pulmonary emboli secondary to aortocaval fistula
  1. Yupar Thet1,
  2. Arun Ranjit1,
  3. Rajeev Ravi1,
  4. Aleem Khand1,2
  1. 1Aintree Cardiac Centre, University of Hospital Aintree, Liverpool, UK
  2. 2Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
  1. Correspondence to Dr Aleem Khand, Aintree Cardiac Centre, University of Hospital Aintree, Longmoor lane, Liverpool L9 7AL, UK; akhand31{at}aol.com

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We present images of a rare, potentially fatal but treatable complication of abdominal aortic aneurysms (AAAs).

An 81-year-old man was admitted with breathlessness on mild exertion, leg swelling and a 2 week history of back pain. He had florid signs of biventricular failure and a pulsatile mass in the abdomen. There was evidence of mild renal impairment. A transthoracic echocardiography revealed global hypokinesia and dilatation of the left and right ventricle. In addition, there was tricuspid regurgitation, a dilated right atrium and evidence of moderate pulmonary hypertension. A contrast enhanced CT scan revealed a large infra-renal AAA measuring 10.3 cm and 12 cm in antero-posterior and coronal diameters respectively (figures 1 and 2). There was marked intramural thrombus formation with an extension of the aneurysm into the proximal common iliac arteries and a focal right internal …

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