"skipMainNavigation"
closeDrawerMenuopenDrawerMenu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
RadioGraphics
Menu
  • Information
    • Previous
    Next
    RSNA Education Exhibits

    Spectrum of CT Findings in Rupture and Impending Rupture of Abdominal Aortic Aneurysms

    Published Online:Mar 1 2007https://doi.org/10.1148/rg.272065026

    Abstract

    Prompt diagnosis of rupture and impending rupture of abdominal aortic aneurysms is imperative. The computed tomographic (CT) findings of ruptured abdominal aortic aneurysms are often straightforward. Most ruptures are manifested as a retroperitoneal hematoma accompanied by an abdominal aortic aneurysm. Periaortic blood may extend into the perirenal space, the pararenal space, or both. Intraperitoneal extravasation may be an immediate or a delayed finding. Discontinuity of the aortic wall or a focal gap in otherwise continuous circumferential wall calcifications may point to the location of a rupture. There usually is a delay of several hours between the initial intramural hemorrhage and frank extravasation into the periaortic soft tissues. Contained or impending ruptures are more difficult to identify. A small amount of periaortic blood may be confused with the duodenum, perianeurysmal fibrosis, or adenopathy. Imaging features suggestive of instability or impending rupture include increased aneurysm size, a low thrombus-to-lumen ratio, and hemorrhage into a mural thrombus. A peripheral crescent-shaped area of hyperattenuation within an abdominal aortic aneurysm represents an acute intramural hemorrhage and is another CT sign of impending rupture. Draping of the posterior aspect of an aneurysmal aorta over the vertebrae is associated with a contained rupture.

    © RSNA, 2007

    References

    • 1 ScottRA, Ashton HA, Kay DN. Abdominal aortic aneurysm in 4,237 screened patients: prevalence, development and management over 6 years. Br J Surg1991; 78: 1122–1125. Crossref, Medline, Google Scholar
    • 2 BengtssonH, Bergqvist D, Sternby NH. Increasing prevalence of abdominal aortic aneurysms: a necropsy study. Eur J Surg1992; 158: 19–23. Medline, Google Scholar
    • 3 SiegelCL, Cohan RH, Korobkin M, Alpern MB, Courneya DL, Leder RA. Abdominal aortic aneurysm morphology: CT features in patients with ruptured and non-ruptured aneurysms. AJR Am J Roentgenol1994; 163: 1123–1129. Crossref, Medline, Google Scholar
    • 4 MaherMM, McNamara AM, MacEneaney PM, Sheehan SJ, Malone DE. Abdominal aortic aneurysms: elective endovascular repair versus conventional surgery— evaluation with evidence-based medicine techniques. Radiology2003; 228: 647–658. Link, Google Scholar
    • 5 ParodiJC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg1991; 5: 491–499. Crossref, Medline, Google Scholar
    • 6 Remy-JardinM, Dequiedt P, Ertzbischoff O, et al. Safety and effectiveness of gadolinium-enhanced multi-detector row spiral CT angiography of the chest: preliminary results in 37 patients with contraindications to iodinated contrast agents. Radiology2005; 235: 819–826. Link, Google Scholar
    • 7 WickyS, Greenfield A, Fan CM, et al. Aortoiliac gadolinium-enhanced CT angiography: improved results with a 16-detector row scanner compared with a four-detector row scanner. J Vasc Interv Radiol2004; 15(9): 947–954. Crossref, Medline, Google Scholar
    • 8 ThomsenHS. Guidelines for contrast media from the European Society of Urogenital Radiology. AJR Am J Roentgenol2003; 181: 1463–1471. Crossref, Medline, Google Scholar
    • 9 HallidayKE, Al-Kutoubi A. Draped aorta: CT sign of contained leak of aortic aneurysms. Radiology1996; 199: 41–43. Link, Google Scholar
    • 10 LederleFA, Johnson GR, Wilson SE, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA2002; 287: 2968–2972. Crossref, Medline, Google Scholar
    • 11 PillariG, Chang JB, Zito J, et al. Computed tomography of abdominal aortic aneurysm: an in vivo pathological report with a note on dynamic predictors. Arch Surg1988; 123: 727–732. Crossref, Medline, Google Scholar
    • 12 MowerWR, Quinones WJ, Gambhir SS. Effect of intraluminal thrombus on abdominal aortic aneurysm wall stress. J Vasc Surg1997; 26: 602–608. Crossref, Medline, Google Scholar
    • 13 GonsalvesCF. The hyperattenuating crescent sign. Radiology1999; 211: 37–38. Link, Google Scholar
    • 14 MehardWB, Heiken JP, Sicard GA. High-attenuating crescent in abdominal aortic aneurysm wall at CT: a sign of acute or impending rupture. Radiology1994; 192: 359–362. Link, Google Scholar
    • 15 AritaT, Matsunaga N, Takano K, et al. Abdominal aortic aneurysm: rupture associated with the high-attenuating crescent sign. Radiology1997; 204: 765–768. Link, Google Scholar
    • 16 MacedoTA, Stanson AW, Oderich GS, Johnson CM, Panneton JM, Tie ML. Infected aortic aneurysms: imaging findings. Radiology2004; 231: 250–257. Link, Google Scholar
    • 17 OrtonDF, LeVeen RF, Saigh JA, et al. Aortic prosthetic graft infections: radiologic manifestations and implications for management. RadioGraphics2000; 20: 977–993. Link, Google Scholar
    • 18 YoshikawaK, Yamaguti T, Nakamura M, et al. The role of dual-phase enhanced helical computed tomography in difficult intestinal bleeding. J Clin Gastroenterol2000; 31: 83–84. Crossref, Medline, Google Scholar
    • 19 WalkerDI, Bloor K, Williams G, et al. Inflammatory aneurysms of the abdominal aorta. Br J Surg1972; 59: 609–614. Crossref, Medline, Google Scholar
    • 20 ArriveL, Correas JM, Leseche G, Ghebontni L, Tubiana JM. Inflammatory aneurysms of the abdominal aorta: CT findings. AJR Am J Roentgenol1995; 165: 1481–1484. Crossref, Medline, Google Scholar
    • 21 PennellRC, Hollier LH, Lie JT, et al. Inflammatory abdominal aortic aneurysms: a thirty-year review. J Vasc Surg1985; 2: 859–869. Crossref, Medline, Google Scholar
    • 22 HaugES, Skomsvoll JF, Jacobsen G, et al. Inflammatory aortic aneurysm is associated with increased incidence of autoimmune disease. J Vasc Surg2003; 38: 492–497. Crossref, Medline, Google Scholar

    Article History

    Published in print: Mar 2007