1. Infrarenal aortic aneurysm: an incidental radiological finding
Marina Yiasemidou, MBBS, MSc

2. Objectives
To demonstrate the importance of extensive revision of imaging testing
To demonstrate the importance of considering alternative diagnosis

3. Imaging options for loin pain
Intravenous Urogram (IVU)
CT Scan
Ultrasound

4. History
71 year old man
Worsening colicky left sided flank pain radiating to his groin for 2 days
One year history of intermittent left sided pain, similar in nature but of reduced severity
No other significant past medical history

5. On Examination A-Patent B- Good bilateral air entry RR:12 C- HS: S1-S2
- Heart rate: 92 bpm,
- Right arm blood pressure 134/87 mmHg
D- GCS 15/15 PEARL
E-tender left loin with guarding
abdomen was otherwise soft
no palpable masses
no renal bruits
normal bowel sounds
femoral pulses: (+) bilaterally, equal
warm, pink extremities

6. Investigastions
Urine dipstick: microscopic haematuria and proteinuria.
Abdominal X-ray: Normal
FBC, U+Es, LFTs: Unremarkable
Intravenous urogram (IVU) (to exclude ureteric calculi)
no renal tract calcifications
normal, unobstructed pelvicalyceal systems
larger distance between the lumbar vertebrae and the left ureter in comparison to the right side

7. Intravenous Urogram

8. ?Alternative diagnosis
Abdominal computerised tomography

9. patient was referred to vascular team
CT findings
9.6 x 9.3 cm infrarenal aortic aneurysm extending up to the bifurcation of the aorta
No ureteric calculi were identified
patient was referred to vascular team

10. CT Abdomen

11. Discussion
History and examination findings consistent with ureteric colic
Physical examination did not reveal any signs indicative of abdominal aortic aneurysm.
Incidental finding of the abnormally unequal distance between the lumbar vertebrae and ureters, identified on IVU imaging, was the only sign of the final diagnosis.

12. Ureteric calculi diagnosis
IVU
Lower radiation
Lower cost
Gives information about functional status of kidneys
degree of obstruction
Spiral CT
Underlying pathology
If eventually needed its diagnostic value will be diminished by attempting IVU first (residual dye, load on kidneys)

13. High threshold of identifying an IVU as normal
Conclusion
High threshold of identifying an IVU as normal

14. Thank you