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There is a large infrarenal abdominal aortic aneurysm. The aneurysmal sac measures 80 x 70 mm in maximum axial dimensions. There is a large amount of periaortic fluid and fat stranding extending into the left side the abdomen overlying the psoas muscle, surrounding the left kidney and elevating it anteriorly, and tracking into the pelvis consistent with haemorrhage. The fluid in the left side of the abdomen measures an average density of 50 HU consistent with acute blood and there is fluid in the pelvis that demonstrates a haematocrit level. No free intraperitoneal gas to suggest perforation. There is moderate faecal loading of the colon.
Arterial phase images through the abdomen and pelvis have been obtained. There is a large fusiform infrarenal measuring 7.2 x 5.7 x 8.8 cm, extending down to the level of the aortic bifurcation. Large posterior pseudoaneurysm measures 5.0 x 1.5 x 5.3 cm. Large amount of surrounding haematoma is not significantly changed from the previous study, extending from the level of the left hemidiaphragm down to the left iliopsoas muscle. Mediolaterally, the haematoma extends from just right of the midline to the left lateroconal fascia, and anteroposteriorly from the left psoas muscle to the anterior abdominal wall. The left kidney is displacd anteriorly by the haematoma. Fusiform aneurysm of the left common iliac artery measures 2.2 cm in diameter. Bilateral common femoral artery opacify normally. Moderate amount of vessel wall calcification. Atrophic bilateral kidneys.
CONCLUSION: Large infrarenal abdominal aortic aneurysm. Large amount of periaortic fat stranding and hyperdense fluid extending into the left side the abdomen consistent with acute aneurysm rupture.