Aorto caval fistula--the "bursting heart syndrome"

Leigh-Smith, Simon; Smith, Robert C.

doi:10.1136/emj.17.3.223

Cited by 25 publications

(20 citation statements)

References 17 publications

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“…Aneurysm rupture, due to parietal erosion, into the venous system is the most common mechanism for this entity, accounting for 80% of all reported cases. Rarely fistula occurs in inflammatory, luetic or mycotic aneurysm, aneurysmal lesion seen in Marfan or Ehlers-Danlos syndrome or Takayasu arteritis [1,2]. Clinical presentation is variable and depends on fistula size and location.…”

Section: Discussionmentioning

confidence: 95%

“…The fistulous tract measured 4 · 1.2 cm with a 1 cm neck. The inferior vena cava appears markedly narrowed due to aneurysm compression edema, hematuria, rectal bleeding); other signs include shock, chest abdominal and back pain, scrotal edema, tenesmus, priapism, poor peripheral pulses [2,3,[5][6][7]. Complications include renal insufficiency, pulmonary embolism and left ventricular failure that can rapidly develop in patients with underlying cardiac disease [3,8].…”

Section: Discussionmentioning

confidence: 99%

“…Mortality is high, ranging from 16 to 66%. Prompt recognition of fistula size, location and early surgical repair is the key to improve patient outcome in this condition and is dependent on physician awareness, clinical presentation and fast imaging demonstration [1][2][3][4][5]. Multidetector row CT (MDCT) is a fast imaging modality that allows a prompt recognition of the fistula [6].…”

Section: Introductionmentioning

confidence: 99%

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MDCT and virtual angioscopy in spontaneous aortocaval fistula

Salerno

Romano

Luca

et al. 2006

Int J Cardiovasc Imaging

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Aortocaval fistula is a rare, less than 1%, but life threatening complication, of abdominal aortic aneurysm. Mortality is high but prompt recognition of the fistula can reduce mortality rate. The multidetector row CT (MDCT) findings in a 69-year-old patient with a complex medical history characterized by previous episodes of myocardial ischemia, is reported. MDCT shows an early homogeneous enhancement of the inferior vena cava, slightly dilated at the liver level and markedly narrowed above the renal vein due to aneurysm compression. The patient underwent to emergency laparotomy but died during surgery for cardiac arrest. MDCT allows a prompt recognition of the fistula and different computerized reconstruction techniques as maximum intensity projection (MIP), multiplanar reformatting (MPR) and virtual angioscopy (VA) added imaging information for surgery.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

MDCT and virtual angioscopy in spontaneous aortocaval fistula

Salerno

Romano

Luca

et al. 2006

Int J Cardiovasc Imaging

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“…In large, high-flow aortocaval fistulas, symptoms of cardiac failure, and sudden central venous hypertension with no clear cause may be the only findings suggesting the diagnosis [8].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Corpulmonale Due to a Common Iliac Artery Aneurysm Fistulating to the Common Iliac Vein

et al. 2016

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This is an unusual case presenting as bilateral lower limb edema and corpulmonale secondary to left ilio-ilial fistula. A 70-year-old man with a background history of hypertension and ischemic heart disease presented to the medical team with bilateral leg swelling and deranged liver and kidney function. An abdominal ultrasound scan detected an aneurysm of the left common iliac artery. A CT angiogram revealed that this aneurysm was fistulating into the left common iliac vein causing right heart failure. This was repaired endovascularly. The procedure was successful and resulted in complete resolution of symptoms and restoration of normal liver function.

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“…Diagnosis before surgery is desirable as it allows preparation by the surgeon for appropriate operative techniques. In one series mortality is 15 % if diagnosis was made before surgery in contrast with 100 % mortality if it is not [4].…”

mentioning

confidence: 97%

Aortocaval fistula

et al. 2014

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A 71-year-old man with a history of diabetes and coronary artery disease, was admitted to the emergency department (ED) with a 4-h history of left-sided abdominal, leg and scrotal pain. He was taking insulin and antiplatelet therapy. Upon arrival at the ED, the patient was responsive, hemodynamically stable, and complaining of abdominal pain. The vital signs were: heart rate 130 beats/min, right arm blood pressure 120/75 mmHg, temperature 37°C and respiratory rate 26 breaths/min. Percutaneous oxygen saturation was 98 % on room air. The lung sounds were clear and symmetrical with no wheezes or crackles; the heart beats were regular without murmurs: the femoral pulses were reduced on the left side, and the extremities were moist and cold with hypoperfusion.A bedside ultrasound study performed by the emergency physician showed an infrarenal abdominal aortic aneurysm (AAA 6.9 9 6.2 cm) with an aortocaval fistula (ACF), as evidenced by a jet effect of aortic blood flow into the inferior vena cava (IVC). An urgent surgery intervention was mandatory. Promptly, an abdominal preoperative computed tomography (CT scan) with contrast-enhanced arterial phase was performed as requested by the surgeon, and it confirmed the presence of the infrarenal abdominal aortic aneurysm (7 cm 9 9 cm of length). During the arterial phase, there was a rapid contrast filling of the inferior vena cava and iliac veins, indicating the presence of a large ACF confirming our hypothesis (Fig. 1). A subsequent three-dimensional CT scan reconstruction in coronary projection has identified a fistula between the aorta and the inferior vena cava just a few centimeters above the iliac vein (Fig. 2).Due to the considerable size of the ACF and the potentially unstable clinical situation, the patient was taken Fig. 1 CT scan: three of the four typical CT findings of ACF on CT are present in this slice. Early contrast enhancement of the inferior vena cava, which has the same density of the adjacent aorta, an associated aortic aneurysm, and loss of normal anatomic space between aorta and inferior vena cava (arrow). Contrast computed tomography simultaneously showed an abdominal infrarenal aortic aneurysm (7 9 9 cm) with communication between the aorta (AO) and the inferior vena cava (IVC). On the right you can see the true and the false lumen of the aortic aneurism, and on the left the aortocaval fistula (arrow)

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Aorto caval fistula--the "bursting heart syndrome"

Cited by 25 publications

References 17 publications

MDCT and virtual angioscopy in spontaneous aortocaval fistula

MDCT and virtual angioscopy in spontaneous aortocaval fistula

An Unusual Case of Corpulmonale Due to a Common Iliac Artery Aneurysm Fistulating to the Common Iliac Vein

Aortocaval fistula

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