Page 35 - Virtual Vascular Vol 4

Psoas shadow
IMAGES

An interesting X-ray showing
multiple secondary inter-
ventions after EVAR to treat Multiple

endoleaks. If EVAR is per- Endoanchors
formed on patients with un-
favorable anatomy the risk
of secondary intervention
and late failure is higher. Palmaz stent
to improve
conformance

Embolization
coils in the
lumbar artery

Embolization
coils and glue
in the sac

• The Yellow arrow refers to “psoas line” or “psoas shadow”. This is the “line”
usually seen on plain abdominal X-ray, which delineates the lateral margin of

the psoas muscles
• Obliteration or diminution in clarity of these lines would suggest
retroperitoneal pathologies such as haematoma, abscess or mass

• The White arrow points to some calcification. The curvilinear calcification
outlines an atherosclerotic arterial wall that suggests the presence of an Glue spillage
abdominal aortic aneurysm (AAA) into the left

• In the presence of such curvilinear calcification suggesting of AAA, together internal iliac
34 with obliteration of the psoas line, a leaking/ruptured AAA with artery 35
retroperitoneal haematoma would be suggested