To explore the diagnostic characteristics of contrast-enhanced ultrasound for endoleak and left perirenal hematoma after endovascular repair of abdominal aortic aneurysm.

Retrospective analysis of the clinical information of a patient with endoleak and left perirenal hematoma following endovascular repair of abdominal aortic aneurysm at the Cardiovascular Surgery Department of the Air Force Medical Center on May 6, 2022 was performed. The advantages of contrast-enhanced ultrasound in the diagnosis of endoleak were discussed, supported by relevant literature.

A 54 year old male patient was admitted with complains of intermittent chest tightness, shortness of breath, and discomfort that had been present for 1 year and worsened for 1 week. Two years ago, the patient was found to have abdominal aortic aneurysm and underwent endovascular aneurysm repair. The general condition of the patient was poor after surgery. Conventional ultrasound showed aneurysmal dilatation of the abdominal aorta with stent echo, while color Doppler ultrasound showed red and blue vortex signals within the aneurysm. There was a hypoechoic mass in the left kidney, and color Doppler showed no obvious blood flow signal in it. Ultrasound contrast examination revealed that no obvious microbubbles entered the left perirenal mass. A microbubble entered the upper half of the perivascular mass around the left lateral wall at the upper end of the abdominal aortic stent and returned to the stent on the right lateral wall. Left perirenal hematoma detected on ultrasound, but no visible signs of ongoing bleeding. Active leakage (I a type endoleak) was visible in the tumor body following stenting for abdominal aortic aneurysm. Abdominal CT indicated the formation of an intramural hematoma at the aneurysm site, with encapsulated fluid accumulation in the left posterior kidney behind the peritoneum (considered a hematoma). The position of the sent was normal, and no abnormal density shadow was found.

For patients with endoleak after endovascular aneurysm repair, contrast-enhanced ultrasound can observe the endoleak site in real time, which makes up for the shortcomings of conventional ultrasound and the lack of dynamic monitoring of enhanced CT, and provides accurate and effective imaging basis for the diagnosis of endoleak.