case_images: PMC11799869_01
case_images: Contrast-enhanced CT before treatment.. (A) Enlarged lymph node in the left axilla (arrow). (B) Soft tissue density masses observed in the hilum and paravertebral thoracic region (arrow). (C) Soft tissue density mass surrounding the descending aorta (arrows). (D) Soft tissue density masses around both internal iliac arteries (yellow arrow and yellow arrowhead). Atherosclerosis-induced calcification was observed in internal iliac arteries.
case_images: cureus-0017-00000077052-i01.jpg
case_images: PMC11799869_01_cureus-0017-00000077052-i01.jpg
case_images: FIG1
case_images: Whole-body contrast-enhanced CT showed lymphadenopathy in the left axilla (Figures 1A-1D).
case_images: Contrast-enhanced CT 1-year post-treatment initiation. . The soft tissue mass around the right internal iliac artery disappeared (yellow arrow), and a dissecting aneurysm appeared in the left internal iliac artery (yellow arrowhead).
case_images: cureus-0017-00000077052-i02.jpg
case_images: PMC11799869_01_cureus-0017-00000077052-i02.jpg
case_images: FIG2
case_images: Contrast-enhanced CT revealed a significant reduction in all previously observed lesions, with the lesion around the right internal iliac artery disappearing completely (Figure 2).
case_images: Contrast-enhanced CT 1.5 years post-treatment initiation.. (A) In an axial image, a new dissecting aneurysm appeared in the right internal iliac artery (yellow arrow). No significant change was observed in the dissecting aneurysm in the left internal iliac artery, which had partially thrombosed, compared to six months ago. Two patent false lumens are visible: one large (yellow double arrow) and one small lumens. (B) In the coronal image, the right false lumen is not thrombosed (yellow arrow) and true lumen is narrowed due to displacement by intimal calcification. Similarly, the true lumen on the left is narrowed, with a small patent false lumen depicted on the cranial side (yellow arrowhead).
case_images: cureus-0017-00000077052-i03.jpg
case_images: PMC11799869_01_cureus-0017-00000077052-i03.jpg
case_images: FIG3
case_images: CT showed no significant changes in the left internal iliac aneurysm; however, a dissecting aneurysm appeared in the right internal iliac artery (Figures 3A, 3B).
case_images: Endovascular therapy.. (A) Aortography shows a large patent false lumen of the dissecting aneurysm in the right internal iliac artery (yellow arrow). In contrast, the dissecting aneurysm in the left internal iliac artery reveals a small cranial (yellow arrowhead) and large patent false lumens (double arrow). (B) An iliac arteriography demonstrated the false lumen(yellow arrow) and narrowing of the proximal true lumen. (C) After placing a covered stent in the right internal iliac artery, the depiction of the false lumen disappeared and narrowing of the true lumen improved.
case_images: cureus-0017-00000077052-i04.jpg
case_images: PMC11799869_01_cureus-0017-00000077052-i04.jpg
case_images: FIG4
case_images: Aortography revealed a large false lumen in the right internal iliac artery aneurysm (Figure 4A). Arteriography of the right internal iliac artery revealed a narrowing of the true lumen (Figure 4B). Then, due to a residual endoleak, an additional 8mm in diameter and 25mm in length Viabahn stent graft was placed proximally, closing the false lumen (Figure 4C).
case_images: Contrast-enhanced CT five months after endovascular therapy.. (Left) The small cranial false lumen of the left internal iliac aneurysm remained, similar to the previous scan (yellow arrowhead), whereas the large caudal false lumen was spontaneously thrombosed and occluded. (Right) The stent placed in the right internal iliac artery remains patent, and the false lumen of the aneurysm is completely thrombosed and occluded (yellow arrow).
case_images: cureus-0017-00000077052-i05.jpg
case_images: PMC11799869_01_cureus-0017-00000077052-i05.jpg
case_images: FIG5
case_images: Six months postoperatively, contrast-enhanced CT showed that the false lumen in the right internal iliac artery was thrombosed and occluded, and the stent remained well-expanded and patent (Figure 5).