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Ruptured Abdominal Aortic Aneurysm

Categorization of Sonographic Findings and Report of 3 New Signs

Department of Radiology, Istituto Pascale, Naples, Italy.

Address correspondence to Orlando Catalano, MD, Department of Radiology, Istituto Pascale, Via Crispi 92, I-80121 Naples, Italy. E-mail: orlandcat{at}tin.it

Objective. The purpose of this study was to categorize the sonographic findings seen in patients with a ruptured abdominal aortic aneurysm (AAA) and to describe 3 previously undescribed sonographic findings. Methods. From January 1997 to December 2003, we evaluated 388 consecutive patients with an AAA (transverse aortic diameter >30 mm). Among these patients, 29 had surgical or computed tomographic demonstration of aneurysm rupture. The remaining 359 were asymptomatic and had no evidence of AAA rupture at follow-up. Results. Findings recognized among 29 positive cases included AAA deformation (n = 12), luminal thrombus inhomogeneity (n = 20), clear interruption of a luminal thrombus (n = 5), retroperitoneal hematoma (n = 22), and hemoperitoneum (n = 11). In addition, 3 previously unreported findings were noted: an intraluminal floating thrombus layer (n = 8), a parietal hypoechoic focus due to aneurysm wall interruption (n = 3), and a para-aortic hypoechoic area adjacent to the bleeding side (n = 4). Aside from AAA deformation and thrombus heterogeneity, no other signs were recognized among subjects with a nonruptured aneurysm. Conclusions. In the past, sonography has been used mainly to rapidly confirm aneurysm presence in the clinical setting of a patient with a suspected rupture. Instead, this retrospective series shows how this imaging technique can frequently identify several direct and indirect signs of aneurysm rupture itself. Moreover, 3 new indicators of AAA rupture have been observed.

Key Words: abdominal aorta • abdominal aortic aneurysm • rupture • sonography

Abbreviations: AAA, abdominal aortic aneurysm • CT, computed tomography