Impending aortic aneurysm rupture – a case report and review of the warning signs

Gish, David; Baer, John; Crabtree, Gordon S.; Shaikh, Bilal; Fareedy, Shoaib Bilal

doi:10.3402/jchimp.v6.32217

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…Shortly before imaging, the patient developed sudden severe abdominal and back pain. CT scan showed early signs of impending rupture, 13 including periaortic fat stranding as reported by the radiologist (Fig 1). Aortic geometry and hemodynamics were preserved at the time of imaging; the patient presented with an unusual case of rupture in evolution, providing a unique timeline for our analysis.…”

Section: Case Reportsupporting

confidence: 56%

A novel combined fluid dynamic and strain analysis approach identified abdominal aortic aneurysm rupture

Forneris

Marotti

Satriano

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Clinical decision-making for surgical repair of abdominal aortic aneurysms based on maximum aortic diameter presents limitations as rupture can occur below threshold for some aneurysms, whereas others are stable at large sizes. The proposed approach combines hemodynamics and geometric indices with in vivo deformation analysis to assess local weakening of the aortic wall for a case of impending rupture that was confirmed during open surgical repair. A new combined index, the Regional Rupture Potential, is introduced to help the assessment of individual aneurysms and their rupture risk, providing a rationale for clinical decisions.

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Section: Case Reportsupporting

confidence: 56%

A novel combined fluid dynamic and strain analysis approach identified abdominal aortic aneurysm rupture

Forneris

Marotti

Satriano

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

View full text Add to dashboard Cite

show abstract

“…As far as the most accepted widespread criteria are represented by the maximum diameter and the expansion rate, there are other important imaging features that radiologists must be aware of, to promptly detect potentially life-threatening conditions ( Table 6 ). These features are considered by most authors as signs of impending rupture (SIR) and include, amongst others, (1) a hyper-attenuating crescent sign, (2) focal wall discontinuity of circumferential calcifications ( Figure 12 A), (3) aortic bulges or blebs, and (4) a draped aorta sign or periaortic stranding [ 108 , 109 ]. These signs are mostly based on CT characteristics of the mural thrombus.…”

Section: Unstable and Impending Rupture Of Thoracic Aorta Aneurysm (Taa)mentioning

confidence: 99%

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

et al. 2022

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Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.

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“…The high-attenuating crescent (HAC) sign is regarded as an indicator of impending rupture or rupture of the abdominal AA. [1][2][3][4][5][6][7][8][9][10][11][12][13] In addition, the HAC sign of a thoracic AA may represent an acute contained or impending rupture, analogous to that described in abdominal AA. 14 This sign is defined as a crescent-shaped high-density area in the aortic wall or a mural thrombus on a computed tomography (CT) image.…”

mentioning

confidence: 98%

Computed Tomography Attenuation Values of the High-Attenuating Crescent Sign Can Discriminate Between Rupture, Impending Rupture, and Non-Rupture of Aortic Aneurysms

Ueda

Hayashi

Ando

et al. 2021

Circ J

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Background: Although the high-attenuating crescent (HAC) sign can indicate aortic aneurysm (AA) impending rupture, the relation of its computed tomography (CT) value to the aneurysmal status remains unclear. This study compared the HAC sign CT-attenuation values among rupture, impending rupture, and non-rupture AA cases. Methods and Results:This included 76 patients (mean age: 77.0 years) diagnosed with HAC sign-associated AA between January 2005 and July 2015. The CT-attenuation values of the HAC sign (H) and aortic lumen (A) using region-of-interest methodology were measured and the H/A ratio was calculated. The study classified patients into the rupture group (R-G, n=36), impending rupture group (IR-G, n=16), and non-rupture group (NR-G, n=24); the H and the H/A ratio were compared among them. Additionally, the H and the H/A ratio cut-offs between the IR-G and NR-G groups were evaluated. The H and the H/A ratio were significantly higher in the R-G and IR-G than in the NR-G (both P<0.001); the H/A ratio was significantly higher in the R-G than in the IR-G (P=0.038). The optimal cut-off for H between the IR-G and NR-G was 50.3 Hounsfield units (area under the curve [AUC]=0.875; sensitivity=87.5%; specific-ity=87.5%), and that for the H/A ratio was 1.3 (AUC=0.909; sensitivity=91.7%; specificity=87.5%).Conclusions: Among patients with AA, the H and the H/A ratio were significantly higher in cases of rupture and impending rupture than in those of non-rupture.

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Impending aortic aneurysm rupture – a case report and review of the warning signs

Cited by 7 publications

References 20 publications

A novel combined fluid dynamic and strain analysis approach identified abdominal aortic aneurysm rupture

A novel combined fluid dynamic and strain analysis approach identified abdominal aortic aneurysm rupture

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

Computed Tomography Attenuation Values of the High-Attenuating Crescent Sign Can Discriminate Between Rupture, Impending Rupture, and Non-Rupture of Aortic Aneurysms

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