Iliac Pseudoaneurysm from Endoleak

A 65-year-old male presented to the emergency department complaining of two hours of severe lower abdominal pain radiating into his left testicle. The patient described a vascular procedure in the past but did not recall the details. An emergent bedside ultrasound was performed to evaluate the abdominal aorta. During the exam an echogenic object consistent with a prior endovascular stent was discovered in the distal aorta prompting further ultrasound evaluation of the iliac artery (Figure). A true lumen (thin black arrow) was visualized with evidence of leak (white arrows) during color Doppler evaluation. The patient was taken emergently to computed tomography and the diagnosis of an iliac artery pseudoaneurysm from an endoleak was confirmed. A pseudoaneurysm is formed after a disruption causes a saccular expansion at the site of injury that is contained by adventitia or perivascular soft tissue. Rupture is common in Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia