A 71 year old man with abdominal pain



Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Razmin Aslani


Case Section



Patient's Information

Gender : Male
Age : 71


Clinical Summary

A 71 year old man with abdominal pain


Imaging Findings

In aortic CT angiography ,saccular aneurysm of left common iliac artery with 9.7 cm dimension is seen. thrombosis is seen within it.Also linear contrast staining within thrombosis is seen .


Differential Diagnosis

contained rupture aneurysm - impending to rupture aneurysm


Final Diagnosis

impending to rupture anuerysm of left common iliac artery


Discussion (Related Text)

Prompt diagnosis of rupture and impending rupture of abdominal aortic aneurysms is imperative.Contained or impending ruptures are difficult to identify. A small amount of periaortic blood may be confused with the duodenum, perianeurysmal fibrosis, or adenopathy. Imaging features suggestive of instability or impending rupture include increased aneurysm size, a low thrombus-to-lumen ratio, and hemorrhage into a mural thrombus. A peripheral crescent-shaped area of hyperattenuation within an abdominal aortic aneurysm represents an acute intramural hemorrhage and is another CT sign of impending rupture. Draping of the posterior aspect of an aneurysmal aorta over the vertebrae is associated with a contained rupture.(1) Aneurysms with a cross-sectional diameter greater than 7 cm have a risk of rupture approximating 20% per year.Thrombus transformation with contrast extravasation into the thrombus and lumen irregularity as findings that may signify impending rupture.The specificity of the “high-attenuating crescent” sign was 93%. For a crescent to be considered high attenuation , the crescent needed to be well defined and of higher attenuation than the psoas muscle on enhanced scans or of higher attenuation than that of the patent lumen on unenhanced scans. Crescents of increased attenuation were present in 21% of ruptured aneurysms and in none of the patients with intact aneurysms.(2) SO Signs of rupture or impending rupture include: draped aorta sign - sign of contained rupture high-attenuation crescent sign - sign of impending rupture retroperitoneal haematoma.(3)



1-Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms. Rakita D, Newatia A, Hines JJ, Siegel DN, Friedman B.Radiographics. 2007 Mar-Apr;27(2):497-507. 2-CT Findings of Rupture, Impending Rupture, and Contained Rupture of Abdominal Aortic Aneurysms.Stephanie A. Schwartz1.Mihra S. Taljanovic,Stephen Smyth,Michael J. O’Brien,Lee F. Rogers.Downloaded from www.ajronline.org by on 12/19/13 from IP address 3-Abdominal aortic aneurysm.Dr Donna D'Souza et al.read at:http://radiopaedia.org/articles/abdominal_aortic_aneurysm


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