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Aortic aneurysm rupture is the most important diagnosis you want to be able to exclude in patients with acute abdominal pain especially when they
present with back or flank pain. LEFT: Subtle periaortic stranding, MIDDLE: Hemorrhage into posterior pararenal and perirenal compartment, RIGHT: Extravasation of iv. contrast On the left we see three patients with aortic aneurysm rupture.
On the left a classical case in a patient with an aneurysm of the abdominal aorta and a large hyperdense retroperitoneal hematoma due to
rupture. Signs of Pending Aneurysm Rupture
The CT features of contained leak or pending rupture of an aortic aneurysm may be subtle and easily overlooked. High-attenuating crescent sign in a patient with subtle evidence of leak adjacent to the right psoas muscle (broad arrow). High-attenuating crescentThe high attenuating crescent represents an acute hematoma within either the mural thrombus or the aneurysmal wall. High-attenuating crescent sign On the left two more cases of the high-attenuating crescent
sign.
Focal discontinuity of intimal calcificationAnother sign of impending rupture or contained leakage is focal discontinuity of intimal calcification. Tangential calcium sign (small arrow) and hemorrhage (broad arrow) Tangential calcium signOn the left we see another example of the tangential calcium sign. LEFT: draped aorta sign.RIGHT: two weeks later there is a rupture Draped AortaOn the left a
patient who presented with backpain. A positive aortic drape sign is considered to be present when the following features are seen:
Draped aorta sign. Patient died 3 hours later. On the left another
patient who presented with backpain. There was no evidence of aneurysm leakage, but we see a draped aorta. Interactive casesInteractive case 1 In the menubar in the upper left, you will find interactive cases. Can you feel an aortic aneurysm before it ruptures?Symptoms of an abdominal aortic aneurysm
Symptoms of an unruptured AAA may include: a pulsating feeling in your stomach (abdomen), usually near your belly button, that's usually only noticeable when you touch it. persistent back pain. persistent abdominal pain.
What are the signs of an aortic aneurysm bursting?Signs and symptoms that a thoracic aortic aneurysm has ruptured or dissected include:. Sharp, sudden pain in the upper back that spreads downward.. Pain in the chest, jaw, neck or arms.. Difficulty breathing.. Low blood pressure.. Loss of consciousness.. Shortness of breath.. Trouble swallowing.. How long does an aortic aneurysm take to rupture?The larger an aneurysm is, the greater the chances are that it will rupture. It is estimated that an abdominal aortic aneurysm that is over 5.5 cm in diameter will rupture within one year in about 3 to 6 out of 100 men. That's why surgery is often recommended. But there may also be good reasons to not have surgery.
Which symptoms indicate that the patient may be experiencing an expansion and impending rupture of an abdominal aortic aneurysm?It is important to note progressive symptoms, which should alert the clinician to the possibility of expansion with imminent rupture. An expanding AAA commonly causes sudden, severe, and constant low back, flank, abdominal, or groin pain. Syncope may be the chief complaint, with pain less prominent.
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