Abstract
A 78-year-old male with a history of hypertension presented to our emergency department with abdominal pain and near syncope. Abdominal examination revealed a palpable mass in the middle-lower quadrants. He underwent urgent abdominal multi-detector computed tomography (MD-CT) that demonstrated, in the unenhanced phase, a huge abdominal aortic aneurysm (AAA) (12.3 cm) (*) with a retro-peritoneal hematoma (Panel A). During the arterial contrast-enhanced phase a direct contrast extravasation from the AAA (*) to the retro-peritoneal space was noted with interval increments in volume (Panel B). In the MD-CT room, the patient manifested hemodynamic decompensation, and during transfer to the operating room, he arrested and died.
Prompt detection of AAA rupture is critical for potential urgent surgical or endovascular treatment with possible improvement of survival percentages.1,2 The risk of AAA rupture is directly proportional to its diameter, with a risk of rupture approximating 20% per year when the diameter exceeds 7 cm. 3 Contrast-enhanced MD-CT has become routine and the first-line imaging modality of a suspected AAA rupture; it documents the size, presence of active extravasation, and relationship of the AAA to the celiac, superior mesenteric, renal, and inferior mesenteric arteries.2,4
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Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this research was funded solely through institutional sources.