Chronic Contained Abdominal Aortic Aneurysm Rupture After Suprarenal Fixation Fatigue Fracture

Pitoulias, Georgios A.; Mavros, Dimitrios M; Pappas, Evaggelos A.; Atmatzidis, Stefanos; Papadimitriou, Dimitri

doi:10.1016/j.avsg.2012.03.015

Cited by 2 publications

(1 citation statement)

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“…1–3 Symptomatology of a CCR has been documented as chronic lower back pain, intermittent abdominal pain in the left lower quadrant (LQ), groin pain, weight loss, and lower extremity weakness or neuropathy. 2–8 Although temporarily encapsulated, a CCR is a ruptured aneurysm which may progress to a free rupture, warranting immediate surgical intervention upon diagnosis. 1…”

Section: Introductionmentioning

confidence: 99%

Duplex Ultrasound Detection of a Chronic Contained Rupture of an Abdominal Aortic Aneurysm

Warren

Roberts

2016

Journal for Vascular Ultrasound

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Introduction Chronic containment of a ruptured abdominal aortic aneurysm (AAA) is a rare clinical phenomenon that is often accompanied by abstract symptomatology, delayed diagnosis, and treatment. We describe a case of chronic contained rupture (CCR) in a hemodynamically stable and asymptomatic patient detected by duplex ultrasound (DU). Patient Description A 71-year-old white male presented to our medical facility to establish cardiac care for newly diagnosed pleural effusion and bilateral lower extremity edema. Physical examination revealed prominent abdominal aortic pulsations. An abdominal DU was ordered to evaluate for an AAA. Methods An abdominal DU examination was performed utilizing a Philips iU22 xMATRIX Ultrasound System equipped with a C5–1 MHz PureWave transducer. The aorta, common iliac and external iliac arteries were evaluated with gray scale, color, and spectral Doppler applications. Imaging Results The DU confirmed the presence of a 5.6 cm × 5.7 cm infrarenal AAA. The lumen was noted to have irregularities and multiple avascular hypoechoic lesions that were reproducible in multiple imaging planes. Computed tomography (CT) confirmed the presence of the 4.8-cm aneurysm accompanied by a 5.6 cm × 4.0 cm multi-lobular fluid collection extending into the mesentery. Active extravasations were not visualized during contrast administration; nevertheless, the appearance of the irregularity was suspicious of aneurysm leak resulting in evolving hematoma. The CCR was treated with a bifurcated intraluminal stent graft. Conclusion This case describes an extremely rare rupture complication that may be present during routine evaluation of the abdominal aorta. Because of its rarity in case presentation, standardized protocol for detection and sonographic presentation remain undocumented.

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