High-attenuation crescent sign

Last revised by Dr Vincent Tatco on 25 Apr 2019

The high attenuating crescent sign represents an acute hematoma within either the mural thrombus or the aneurysm wall, especially when detected on unenhanced CT scans. It is a specific sign of impending abdominal aortic aneurysm (AAA) rupture or so-called contained rupture.


The hyperattenuation is caused by fresh blood that first insinuates itself into the mural thrombus and later penetrates the aortic wall. Thus, the pathophysiology is not similar to that of an intramural hematoma, in which hemorrhage occurs from within the aortic wall.

The sensitivity of the high-attenuating crescent sign as an indication of a complicated aneurysm is 77%; specificity, 93%; and positive predictive value of 53%.

Treatment and prognosis

When seeing this sign in an aneurysm, especially in patients with pain, it is warranted to inform the referring physician or surgeon about the high risk for aneurysmal rupture, even if there are no primary or frank signs of leakage. This condition may require emergent surgical management and warrants close vitals monitoring.

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Cases and figures

  • Case 1: hyperattenuating crescent sign
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