Ruptured abdominal aortic aneurysm

Case contributed by Dr Ian Bickle

Presentation

Elderly male with know history of an un-operated AAA. Back pain for 6 hours. Hypotensive. Ruptured AAA?

Patient Data

Age: 92
Gender: Male
Modality: CT

8.2cm juxta-renal AAA, the superior aspect of the sac is at the level of the origin of the left renal artery. The aneurysm extends to the aortic bifurcation.

High attenuation fluid in the left side of the retroperitoneum and surrounding the aneurysm sac.

Contrast extravasates from the aneurysm sac between 2 and 3 O'clock.

Case Discussion

A ruptured abdominal aortic aneurysm request is one of the 'hottest' cases you will have on your CT scanner in terms of need for speed.

Far more common in males, it typically presents with back pain and hypotension.

A non-contrast CT is really all that is required in an emergency to identified free retroperitoneal blood and the aneurysm.  However, contrast is given by many.

As well as the aneurysm itself - typically with internal thrombus and wall calcification the key finding is Retroperitoneal haemorrhage adjacent the aneurysm. Peri-aortic blood may extend into adjacent spaces like the perirenal or pararenal spaces or less commonly intra-peritoneal extension.

The retroperitoneal free fluid HU can be measured if reassurance is required that it is blood.

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Case Information

rID: 48187
Case created: 23rd Sep 2016
Last edited: 27th Sep 2016
System: Vascular
Tag: dinew
Inclusion in quiz mode: Included

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