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Clostridium septicum Infrarenal Aortitis Secondary to Occult Cecal Adenocarcinoma

¹ Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway, St. Louis, MO 63110.
² Department of Vascular Surgery, Washington University School of Medicine, 660 S Euclid, St. Louis, MO 63110.

View larger version (113K): [in a new window]   Fig. 1A. —77-year-old woman transferred to our institution with abdominal pain, fever, and leukocytosis. Unenhanced axial CT image shows massively enlarged kidneys nearly replaced by innumerable mixed-density cysts, consistent with known history of adult polycystic kidney disease. Numerous pockets of gas are visible within intimal layer of infrarenal aortic aneurysm and retroperitoneum. Infiltration of surrounding retroperitoneal fat due to inflammation is also present. Arrows = gas in aortic wall.

View larger version (151K): [in a new window]   Fig. 1B. —77-year-old woman transferred to our institution with abdominal pain, fever, and leukocytosis. Coronal reconstructions show ill-defined mass in region of cecum that corresponds to cecal adenocarcinoma. Cecal tip is thickened, and small amount of pericecal fluid can be seen. In anterior right lower quadrant, possible site of perforation with extension of mass into abdominal wall (arrow, B) is seen. Arrows in C = gas surrounding perforated colon cancer.

View larger version (155K): [in a new window]   Fig. 1C. —77-year-old woman transferred to our institution with abdominal pain, fever, and leukocytosis. Coronal reconstructions show ill-defined mass in region of cecum that corresponds to cecal adenocarcinoma. Cecal tip is thickened, and small amount of pericecal fluid can be seen. In anterior right lower quadrant, possible site of perforation with extension of mass into abdominal wall (arrow, B) is seen. Arrows in C = gas surrounding perforated colon cancer.

View larger version (134K): [in a new window]   Fig. 2A. —91-year-old woman with diffuse abdominal pain and neutrophilia. Contrast-enhanced CT image shows gas dissecting along intimal layer of abdominal aorta from level of superior mesenteric artery to iliac bifurcation. Marked periaortic inflammatory stranding is present. Aorta is atherosclerotic and contains mural thrombus but is normal in caliber. Arrow = gas in aortic wall.

View larger version (158K): [in a new window]   Fig. 2B. —91-year-old woman with diffuse abdominal pain and neutrophilia. Contrast-enhanced CT images obtained near iliac bifurcation show large soft-tissue mass (arrows) characterized by marked mural thickening of proximal transverse colon. No evidence of bowel obstruction is present. Gas tracking along course of common iliac arteries is again noted.

View larger version (155K): [in a new window]   Fig. 2C. —91-year-old woman with diffuse abdominal pain and neutrophilia. Contrast-enhanced CT images obtained near iliac bifurcation show large soft-tissue mass (arrows) characterized by marked mural thickening of proximal transverse colon. No evidence of bowel obstruction is present. Gas tracking along course of common iliac arteries is again noted.

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