2012 June 29 – An explosive urinary tract infection (Clinical Pictures)

Dr Grégory Verhoest MD , Tanguy Rohou MD, François Gerard MD, Romain Huet MD, Prof Karim Bensalah MD. The Lancet, Early Online Publication, 29 June 2012
A 68-year-old man complained of urinary frequency and hypogastric discomfort. He was a smoker and had hypertension. Digital rectal examination showed a painful prostate but he had no fever. Urine analysis showed a pyuria and a bacteriuria of enterococcus species. The patient was treated with amoxicillin. 2 days after his admission, he suddenly developed acute right flank pain with hypotension. Blood tests showed a decrease in haemoglobin from 140 g/L on admission to 70 g/L.

The CT showed that an abdominal aortic aneurysm was fissured in the retroperitoneum but with no intraperitoneal bleeding on non-contrast images (figure A). During the injection of contrast media, the CT showed in real time the intraperitoneal rupture of the aneurysm (figure B and C). A left thoracotomy was done immediately in the radiology room to clamp the aorta and prevent the patient bleeding out. Despite graft repair of the aorta, he died a few hours later because of cardiogenic shock. Aortic aneurysm rupture is a devastating complication with a high mortality rate, even when treated by experienced teams, and even when the diagnosis is made promptly.
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