Ruptured AAA?

CTSVS 2018

Hypotension, back or abdominal pain, known or newly found aneurysm — minutes matter.

Answer the surgeon

Straight to the OR or emergent EVAR — nothing in the report should delay that call.

Your answer must state:

Rupture present: retroperitoneal hematoma contiguous with the aneurysm
Maximum aneurysm diameter
Active extravasation
Features of possible instability on an intact aneurysm, interpreted with symptoms, size, growth, and other findings
Basic EVAR anatomy if hemodynamics allow: neck length/diameter, iliac access

Key and direct findings

1.Periaortic retroperitoneal hematoma
Hematoma contiguous with the aneurysm wall is the diagnosis; it tracks along the psoas and perirenal spaces.
Pitfall: Rupture is usually diagnosable on the unenhanced series alone — do not delay the answer for a full protocol or renal function.
2.Active contrast extravasation
Contrast outside the lumen into the hematoma marks ongoing hemorrhage.
3.Wall discontinuity
A focal defect in the aortic wall or interrupted intimal calcification at the hematoma.
4.Draped-aorta sign
The posterior aortic wall loses its fat plane and drapes over the vertebral body — contained leak.

Supportive signs & checks

1.Hyperattenuating crescent
Crescentic high attenuation within mural thrombus on unenhanced CT indicates acute intramural hemorrhage and possible aneurysm instability. In isolation it does not prove impending rupture; integrate symptoms, aneurysm size/growth, periaortic stranding, and other rupture signs.
2.Contained rupture can look quiet
A hemodynamically silent contained rupture still needs the vascular surgeon tonight.
3.Intact but symptomatic
A tender, symptomatic AAA without rupture signs still goes down the emergency pathway — write 'no rupture' explicitly rather than staying silent.

Wet-read snippets

Fill the blanks, then copy into your preliminary report.

Positive

Ruptured infrarenal AAA (max ___ cm) with ___ retroperitoneal hematoma ___ active extravasation. Communicated to ___ at ___.

Negative

Infrarenal AAA, max ___ cm, intact — no periaortic hematoma, no hyperattenuating crescent or draped aorta.

Related workflows

Abdominal aortic aneurysm — US / CT

Sources

SVS practice guidelines on the care of patients with AAA — Chaikof EL et al. J Vasc Surg (2018)
Spectrum of CT findings in rupture and impending rupture of AAA — Rakita D et al. RadioGraphics (2007)
The hyperattenuating crescent sign is not necessarily a sign of impending AAA rupture — Stoecker JB et al. Ann Vasc Surg (2022)

Content review: Content pending clinical review · 2026-07-15

Educational reference for trained clinicians. Verify every result against the cited original guideline before use. Not a substitute for clinical judgment or medical advice.