Abdominal aortic aneurysm with thrombus fissuration

Case contributed by Dr Abdel-Rahman Abdel-Halim

Presentation

Abdominal pain, palpable abdominal mass.

Patient Data

Age: 70
Gender: Female

Fusiform aneurysmal dilatation of the infrarenal aorta measuring about 7x6 cm in its maximum axial diameters and extends for about 13 cm in length. A mural crescentic thrombus is seen with a linear contrast streak seen extending from the lumen into the mural thrombus indicative of thrombus fissuration.

Mural calcifications are noted.

Other findings: left renal stone, right renal simple cyst, dorsolumbar spondylodegenerative changes.

A mural crescentic thrombus is seen with a linear contrast streak (red arrow) seen extending from the lumen into the mural thrombus indicative of thrombus fissuration.

Case Discussion

An aneurysm is defined as a more than 50% increase in diameter compared with the expected normal diameter vessel. A less than 50% increase is termed ectasia.

An infrarenal aorta considered to be aneurysmal if it is 3 cm in diameter or greater. Some authors consider 3.5 cm in diameter to be a better “cut off point.”

Aortic wall degeneration secondary to atherosclerotic disease, as in our case, is probably the most common cause responsible for the formation of AAAs.

Thrombus fissuration is a worrisome sign that may point to impending rupture of an aortic aneurysm.

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