High output cardiac failure and paradoxical pulmonary emboli secondary to aortocaval fistula
- Yupar Thet1,
- Arun Ranjit1,
- Rajeev Ravi1,
- Aleem Khand1,2
- 1Aintree Cardiac Centre, University of Hospital Aintree, Liverpool, UK
- 2Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
- Correspondence to Dr Aleem Khand, Aintree Cardiac Centre, University of Hospital Aintree, Longmoor lane, Liverpool L9 7AL, UK; akhand31{at}aol.com
- Congestive heart failure
- pulmonary circulation and disease
- CT and MRI
- other arteriosclerosis
- arterial thrombosis
- cardiology
- general medicine (see internal medicine)
- radiology and imaging
- adult cardiology
- cardiac epidemiology
- coronary heart disease
- coronary intervention
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 …
