Abdominal aortic aneurysm with thrombus fissuration

Case contributed by Yaïr Glick
Diagnosis certain


Abdominal pain in a patient with a known AAA.

Patient Data

Age: 95 years
Gender: Female

Slight aneurysmal aortic dilatation just above the diaphragm with plaque ulceration - unchanged, compared to a previous study done 2 years earlier (not shown).

Stenosis at the origin of the celiac trunk and SMA - unchanged.

Long infrarenal saccular aortic aneurysm with a maximal diameter of 73 mm at its superior portion and 66 mm at its inferior portion, compared to 67 mm and 64 mm, respectively, on the previous study. The aneurysm terminates caudal to the origin of the right CIA and contains a large mural thrombus with a linear infiltration of contrast material, representing fissuration. There is chronic dissection in the wall of the aneurysm, demarcated by delicate punctate arcuate calcification traversing the large thrombus. All findings are visible on the previous study.

Additional findings:
All chambers of the heart are dilated. There is reflux of contrast material into the IVC and hepatic veins without pulmonary embolic disease, indicative of right heart failure.
Bilateral moderate pleural effusion.
Large hiatal hernia containing approximately half of the stomach.
Bilateral simple cortical renal cysts.

Case Discussion

The patient complained of abdominal pain and had a known abdominal aortic aneurysm (AAA), which is why the ER clinicians were concerned about AAA rupture.
There was fissuration of the AAA mural thrombus on the previous scan done 2 years previously but surprisingly, the fissure had not advanced during the interval.

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