Chronic contained posterior rupture of large abdominal aortic aneurysm missed on pre-operative CT imaging

Abstract

Objectives We discuss the case of a 9.0 cm chronic contained ruptured abdominal aortic aneurysm in a stable 60 year-old male presenting in the ambulatory setting, which was identified intraoperatively after being missed on pre-surgical imaging. We also present a relevant literature review of the signs, symptoms, and imaging features of this rare vascular phenomenon. Methods Thorough physical examination at a primary care clinic revealed a pulsatile but non-tender abdominal aortic aneurysm. CT imaging demonstrated a 9.0 cm abdominal aortic aneurysm with no signs of overt rupture that met criteria for urgent open surgical repair. Results Intraoperatively, an inflammatory aorta with posterior rupture into the spinal column was identified, which was repaired with a bifurcated aortic graft. The patient was well at 6-month follow-up. Conclusions This case highlights the importance of careful CT imaging review in patients with abdominal aortic aneurysms, the elusive presentation of chronic aneurysm ruptures, and the value of thorough abdominal examination in patients with cardiovascular risk factors.

Keywords

• Chronic contained rupture
• Abdominal aortic aneurysm
• Physical examination
• CT imaging criteria