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CT Findings of Rupture, Impending Rupture, and Contained Rupture of Abdominal Aortic Aneurysms

Stephanie A. Schwartz1, Mihra S. Taljanovic1, Stephen Smyth1, Michael J. O'Brien1 and Lee F. Rogers1

1 All authors: Department of Radiology, The University of Arizona Health Sciences Center, 1501 N Campbell Ave., PO Box 245067, Tucson, AZ 85724-5067.


Figure 1
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  		Fig. 1A —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. Axial T1- and T2-weighted MR images show large right retroperitoneal hematoma containing flow void (arrows).

 

Figure 2
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  		Fig. 1B —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. Axial T1- and T2-weighted MR images show large right retroperitoneal hematoma containing flow void (arrows).

 

Figure 3
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  		Fig. 1C —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. Contiguous axial CT angiograms obtained immediately after MRI reveal large right retroperitoneal hematoma with contrast extravasation from posterolateral aorta (arrows, C and E). Operatively, large right retroperitoneal hematoma was seen, and pathologic evaluation revealed area of aortic wall discontinuity and associated organized hematoma.

 

Figure 4
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  		Fig. 1D —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. Contiguous axial CT angiograms obtained immediately after MRI reveal large right retroperitoneal hematoma with contrast extravasation from posterolateral aorta (arrows, C and E). Operatively, large right retroperitoneal hematoma was seen, and pathologic evaluation revealed area of aortic wall discontinuity and associated organized hematoma.

 

Figure 5
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  		Fig. 1E —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. Contiguous axial CT angiograms obtained immediately after MRI reveal large right retroperitoneal hematoma with contrast extravasation from posterolateral aorta (arrows, C and E). Operatively, large right retroperitoneal hematoma was seen, and pathologic evaluation revealed area of aortic wall discontinuity and associated organized hematoma.

 

Figure 6
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  		Fig. 1F —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. CT angiograms obtained 3 months before MRI show irregular contour of posterolateral aorta (arrows, G) with surrounding soft-tissue density (arrows, H), compatible with unrecognized contained rupture.

 

Figure 7
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  		Fig. 1G —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. CT angiograms obtained 3 months before MRI show irregular contour of posterolateral aorta (arrows, G) with surrounding soft-tissue density (arrows, H), compatible with unrecognized contained rupture.

 

Figure 8
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  		Fig. 1H —67-year-old man with known abdominal aortic aneurysm who had 3-month history of lower back and right groin pain. Patient underwent MRI of lumbar spine and pelvis. CT angiograms obtained 3 months before MRI show irregular contour of posterolateral aorta (arrows, G) with surrounding soft-tissue density (arrows, H), compatible with unrecognized contained rupture.

 

Figure 9
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  		Fig. 2A —Elderly man with acute onset of back pain. Axial CT angiograms show aortocaval fistula (arrow) and right retroperitoneal hemorrhage.

 

Figure 10
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  		Fig. 2B —Elderly man with acute onset of back pain. Axial CT angiograms show aortocaval fistula (arrow) and right retroperitoneal hemorrhage.

 

Figure 11
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  		Fig. 2C —Elderly man with acute onset of back pain. Axial CT angiograms show aortocaval fistula (arrow) and right retroperitoneal hemorrhage.

 

Figure 12
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  		Fig. 3A —87-year-old man with 12-hour history of severe back pain. Enhanced axial CT images reveal 7 x 9 cm abdominal aortic aneurysm with high-attenuation crescents within mural thrombus (thick arrows, A and B) and minimal periaortic stranding (thin arrows, C). Contained rupture was present at surgery.

 

Figure 13
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  		Fig. 3B —87-year-old man with 12-hour history of severe back pain. Enhanced axial CT images reveal 7 x 9 cm abdominal aortic aneurysm with high-attenuation crescents within mural thrombus (thick arrows, A and B) and minimal periaortic stranding (thin arrows, C). Contained rupture was present at surgery.

 

Figure 14
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  		Fig. 3C —87-year-old man with 12-hour history of severe back pain. Enhanced axial CT images reveal 7 x 9 cm abdominal aortic aneurysm with high-attenuation crescents within mural thrombus (thick arrows, A and B) and minimal periaortic stranding (thin arrows, C). Contained rupture was present at surgery.

 

Figure 15
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  		Fig. 4A —87-year-old man with known aneurysm and back pain. Axial enhanced CT image shows 7-cm abdominal aortic aneurysm with faint crescentic area of increased attenuation within mural thrombus (arrows). Patient was not surgical candidate due to comorbid conditions.

 

Figure 16
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  		Fig. 4B —87-year-old man with known aneurysm and back pain. Enhanced CT image obtained 3 months after A shows anterior aneurysm rupture (black arrow) with associated retroperitoneal hemorrhage (white arrows).

 

Figure 17
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  		Fig. 5A —Elderly man with 3-day history of back pain. Enhanced CT images show 5-cm abdominal aortic aneurysm with draping of posterior wall over vertebral body (arrows). Contained rupture was found at surgery, with vertebral body visible through aortic lumen.

 

Figure 18
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  		Fig. 5B —Elderly man with 3-day history of back pain. Enhanced CT images show 5-cm abdominal aortic aneurysm with draping of posterior wall over vertebral body (arrows). Contained rupture was found at surgery, with vertebral body visible through aortic lumen.

 

Figure 19
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  		Fig. 6A —Elderly man with abdominal pain. Enhanced CT images show 5-cm abdominal aortic aneurysm with irregular posterior aortic contour and draping of aorta over vertebral body (arrows). Patient suffered cardiac arrest shortly after CT. Autopsy revealed pneumonia as cause of death, but aortic wall was paper thin and adherent to vertebral body.

 

Figure 20
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  		Fig. 6B —Elderly man with abdominal pain. Enhanced CT images show 5-cm abdominal aortic aneurysm with irregular posterior aortic contour and draping of aorta over vertebral body (arrows). Patient suffered cardiac arrest shortly after CT. Autopsy revealed pneumonia as cause of death, but aortic wall was paper thin and adherent to vertebral body.

 

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