Ruptured aortic pseudo-aneurysm: a rare presentation as aortocaval fistula

Pseudo-aneurysms after abdominal aortic replacement are rare, occurring in less than 1% of operated patients. Usually asymptomatic, they may present clinically as a pulsatile mass or less commonly complicated with rupture. Aortocaval fistulas are rare, usually related to ruptured aortic aneurysms or trauma. A case of aortocaval fistula secondary to a ruptured pseudoaneurysm in a 81 year old woman is reported. After an infrarenal aortic aneurysm repair, the patient remained asymptomatic for 7 years, but abdominal pain and syncope developed and promoted further investigation. She was found to have a 6 cm by 6 cm retroaortocaval false aneurysm which had ruptured into the inferior vena cava. Computed tomography with intravenous contrast suggested the diagnosis and color Doppler ultrasound failed to confirm it. The etiology and management of this rare case are discussed.