Huge Aortic Aneurysm? Massive Fistula!

A 73 year old man presented with lumbar pain, dyspnoea, and oliguria. A tender pulsatile abdominal mass with a thrill and bilateral lower limb oedema were noted. Abdominal X-ray revealed a giant calcified spherical mass (A, arrows). Computed tomography angiography showed a 14 cm infrarenal abdominal aortic aneurysm associated with filling of the inferior vena cava with contrast in the arterial phase filling (B, arrow). Blood results revealed a serum creatinine of 5.2 mg/dL and N-terminal pro B-type natriuretic peptide of 25 000 pg/dL. The patient underwent open surgical aneurysm and aortocaval fistula repair (aortobifemoral graft) and was discharged on post-operative day 10.Image 1