Emphysematous aortitis in a diabetic patient: a rare and life-threatening CT diagnosis

A man in his 60s with insulin-dependent type 2 diabetes mellitus presented with concerns of fever, lower abdominal pain and generalised weakness shortly after returning from Caribbean travel. Imaging demonstrated emphysematous aortitis involving the infrarenal abdominal aorta, with associated penetrating aortic ulcer and pseudoaneurysm. Concurrent blood cultures confirmed an infection with Salmonella species. The patient's emphysematous aortitis was successfully treated by vascular surgery via an emergent surgical resection of the infected vessel and aorto-biliac reconstruction with a cryopreserved homograft. The patient was hemodynamically stabilised and consequently discharged with continued outpatient pharmacological management of Salmonella typhi infection with a 6-week course of intravenous ceftriaxone and subsequent lifelong amoxicillin-clavulanate suppression. On 3-month follow-up, imaging demonstrated interval postprocedural changes of prior aorto-biliac endograft placement, with a dissection flap in the infrarenal aorta that resolves just proximal to the aortic bifurcation. Aortic infections are rare and have a high rate of mortality, even with both pharmacologic and non-pharmacologic interventions. This case demonstrates the importance of recognising emphysematous aortitis, an aortic infection, on CT imaging and initiating prompt surgical and antimicrobial management.