Role of Imaging in Aortic Aneurysm with Rupture

OBJECTIVES: � To evaluate the role of imaging in a patient presenting with acute chest& abdomen pain, unimpressive back pain who are heamodynamically unstable to ensure early diagnosis& treatment. Materials& Methods: All patients who came to Department of Radio diagnosis with chief complaints of severe abdominal pain, fever, vomitings, hypotension and pulsatile abdominal mass etc& positive blood cultures, clinical signs of infection (leukocytosis, fever, an elevated C-reactive protein [CRP] concentration), and radiologic findings typical of AA. Ultrasound is the initial imaging modality of choice, as it is not associated with radiation hazards encountered wt x-rays/CT. CECT is the main diagnostic modality to detect aneurysms. MRI used in some cases. Graft infection and aorto-enteric fistulas were excluded. Results: � 10 cases presented with severe abdominal pain. CECT showing multi lobulated saccular outpouching from abdominal aorta with with adjacent retroperitoneal para-aortic collection with air pockets. Contrast shows extravastion of contrast from the saccular aneurysm into retroperitoneal collection with hematoma. � 35 year male patient, IV drug abuser Patient present with acute abdominal pain. CT shows ascending aorta dilatation (5cm) with saccular outpouching. � 52y old male patient, post CABG incidentally identified ascending& arch of aorta dilatation with partial eccentric thrombus& adjacent soft tissue stranding and reactive lymphadenopathy. � 4 cases presented with severe chest pain radiating to abdomen shows hematoma noted adjacent to thoracic aorta. � 24y old woman presented with fever, right loin pain& hypertension. Plain CT shows no significant abnormality. On CT angiography shows abdominal aorta distal to renal vessels shows aneurysm with near complete occlusion by thrombus. � 25y old pregnant woman known case of infective endocarditis came with chest and abdominal pain. CT shows a long segment aortic aneurysm extending from thoracic aorta extending upto abdominal aorta proximal to renal vessels. � All results were correlated with surgical findings. Conclusion: � Misdiagnosis and treatment of aortic aneurysms as low back pain, co-existing connective-tissue disease such as systemic lupus erythematosus and rheumatoid arthritis are risk factors for aneurysm-related death. Imaging is the modality of choice to diagnose aortic aneurysms for early management& prognosis evaluation. USG& CT are being used. Endovascular repair should be considered as an alternative option to the open repair of aortic aneurysms.