Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic Aneurysm
Abdominal aortic aneurysm (AAA) is a potentially life-threatening condition characterized by abnormal dilation of the abdominal aorta, typically due to chronic arterial wall degeneration. Aorto-caval fistula (ACF) is a rare but serious complication of AAA, occurring in less than 1% of cases overall,...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-07-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/23247096251358669 |
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| author | Lamia Azizi MD Antonio Al Hazzouri MD Philippe Attieh MD Rose Mary Daou MD Joya Ghaleb MD Karam Karam MD Mehsen Azizi MD Elias Fiani MD |
| author_facet | Lamia Azizi MD Antonio Al Hazzouri MD Philippe Attieh MD Rose Mary Daou MD Joya Ghaleb MD Karam Karam MD Mehsen Azizi MD Elias Fiani MD |
| author_sort | Lamia Azizi MD |
| collection | DOAJ |
| description | Abdominal aortic aneurysm (AAA) is a potentially life-threatening condition characterized by abnormal dilation of the abdominal aorta, typically due to chronic arterial wall degeneration. Aorto-caval fistula (ACF) is a rare but serious complication of AAA, occurring in less than 1% of cases overall, with incidence increasing in the setting of rupture. ACF involves the formation of an abnormal communication between the abdominal aorta and the inferior vena cava (IVC), resulting in blood shunting from the arterial to the venous system. This can cause reduced organ perfusion, high-output cardiac failure, and multiorgan dysfunction. We present the case of a 65-year-old hypertensive male with a known AAA who presented with 2 days of abdominal pain but no systemic or gastrointestinal symptoms. Physical examination revealed periumbilical tenderness, while laboratory results were normal. Contrast-enhanced computed tomography of the abdomen revealed a large (10 cm) infrarenal AAA with evidence of rupture, mural thrombus, and a fistulous connection to the IVC. The patient underwent successful endovascular repair with complete resolution of the aneurysm and fistula, as shown in follow-up imaging. This case highlights the importance of high clinical suspicion and the role of early imaging in diagnosing ACFs, even in the absence of classical signs or lab abnormalities. The aim is to raise awareness of such atypical presentations and emphasize our case’s uniqueness in its silent, stable, yet severe presentation. |
| format | Article |
| id | doaj-art-03d238a2507d48daa10371401b7ff7da |
| institution | Kabale University |
| issn | 2324-7096 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj-art-03d238a2507d48daa10371401b7ff7da2025-08-20T03:58:17ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962025-07-011310.1177/23247096251358669Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic AneurysmLamia Azizi MD0Antonio Al Hazzouri MD1Philippe Attieh MD2Rose Mary Daou MD3Joya Ghaleb MD4Karam Karam MD5Mehsen Azizi MD6Elias Fiani MD7University of Balamand, Beirut, LebanonUniversity of Balamand, Beirut, LebanonUniversity of Balamand, Beirut, LebanonUniversity of Balamand, Beirut, LebanonUniversity of Balamand, Beirut, LebanonUniversity of Balamand, Beirut, LebanonUniversity of Balamand, Beirut, LebanonUniversity of Balamand, Beirut, LebanonAbdominal aortic aneurysm (AAA) is a potentially life-threatening condition characterized by abnormal dilation of the abdominal aorta, typically due to chronic arterial wall degeneration. Aorto-caval fistula (ACF) is a rare but serious complication of AAA, occurring in less than 1% of cases overall, with incidence increasing in the setting of rupture. ACF involves the formation of an abnormal communication between the abdominal aorta and the inferior vena cava (IVC), resulting in blood shunting from the arterial to the venous system. This can cause reduced organ perfusion, high-output cardiac failure, and multiorgan dysfunction. We present the case of a 65-year-old hypertensive male with a known AAA who presented with 2 days of abdominal pain but no systemic or gastrointestinal symptoms. Physical examination revealed periumbilical tenderness, while laboratory results were normal. Contrast-enhanced computed tomography of the abdomen revealed a large (10 cm) infrarenal AAA with evidence of rupture, mural thrombus, and a fistulous connection to the IVC. The patient underwent successful endovascular repair with complete resolution of the aneurysm and fistula, as shown in follow-up imaging. This case highlights the importance of high clinical suspicion and the role of early imaging in diagnosing ACFs, even in the absence of classical signs or lab abnormalities. The aim is to raise awareness of such atypical presentations and emphasize our case’s uniqueness in its silent, stable, yet severe presentation.https://doi.org/10.1177/23247096251358669 |
| spellingShingle | Lamia Azizi MD Antonio Al Hazzouri MD Philippe Attieh MD Rose Mary Daou MD Joya Ghaleb MD Karam Karam MD Mehsen Azizi MD Elias Fiani MD Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic Aneurysm Journal of Investigative Medicine High Impact Case Reports |
| title | Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic Aneurysm |
| title_full | Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic Aneurysm |
| title_fullStr | Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic Aneurysm |
| title_full_unstemmed | Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic Aneurysm |
| title_short | Silent Rupture: Atypical Presentation of Aorto-Caval Fistula Secondary to Giant Abdominal Aortic Aneurysm |
| title_sort | silent rupture atypical presentation of aorto caval fistula secondary to giant abdominal aortic aneurysm |
| url | https://doi.org/10.1177/23247096251358669 |
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