A 74-year-old man presented to the primary care physician with a 3-month history of weight loss, anorexia, and back pain. His medical history was significant for hypertension, hyperlipidemia, and kidney stones. His surgical history was significant for a bilateral staged carotid endarterectomy in 1999 and 2000 and an open repair of a 7.4-cm transverse diameter juxtarenal abdominal aortic aneurysm with a knitted Dacron tube graft (18 mm) in 2014. Ligation of the left renal vein adjacent to the inferior vena cava was performed to gain proximal control of the aorta. The patient underwent extraction of a tooth secondary to an abscess 4 months earlier. Physical examination revealed poor dental hygiene and findings in the lower extremity suggestive of postthrombotic syndrome. The patient was afebrile with a heart rate of 108 beats per minute and a leukocyte level of 11 600/cm (normal range, 4000-11 000/cm), with 84% polymorphic neutrophils (normal, <75%); erythrocyte sedimentation rate was 57 mm/h (normal range, 0-10 mm/h), and C-reactive protein level was 15.9 mg/dL (normal, <0.6 mg/dL [to convert to nmol/L, multiply by 9.524]). Computed tomography (CT) of the abdomen and pelvis was performed (Figure 1A and B).

一位74岁的男子向基层医疗医生介绍了3个月的体重减轻，厌食症和背痛病史。他的病史对高血压，高脂血症和肾结石具有重要意义。他的外科手术史对于1999年和2000年双侧颈动脉内膜切除术和2014年用Dacron编织移植物（18 mm）进行开腹手术修复横径为7.4 cm的近颈腹主动脉瘤具有重要意义。左肾静脉结扎进行下腔静脉切除术以获得主动脉的近端控制。该患者在脓肿继发于四个月前接受了拔牙。体格检查发现牙齿卫生差，下肢发现提示血栓形成后综合症。患者发热，心律为每分钟108次搏动，白细胞水平为11600 / cm（正常范围，4000-11 000 / cm），中性粒细胞多态性为84％（正常，<75％）；红细胞沉降速率为57 mm / h（正常范围，0-10 mm / h），C反应蛋白水平为15.9 mg / dL（正常，<0.6 mg / dL [转换为nmol / L，乘以9.524 ]）。进行腹部和骨盆的计算机断层扫描（CT）（图1A和B）。