The Ruptured Abdominal Aorta: Diagnostics

Imaging plays a key role in the diagnosis and management of ruptured abdominal aortic aneurysms (RAAA) as well as acute conditions that may result in aortic rupture, including aortic intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU). Today, the most commonly used diagnostic tools for ruptured AAA include computed tomography (CT) and focused assessment with sonography for trauma (FAST). CT scans tailored to evaluate the aorta should include a precontrast scan and a high-quality CT angiogram to evaluate the aortic lumen and to permit multiplanar reconstructions (MPR) to potentially provide measurements for endoluminal therapy. Radiologists and clinicians evaluating these scans need to understand the findings of aortic rupture and related conditions, including the high-attenuation crescent, tangential calcium, and draped aorta signs. FAST is tailored to evaluate free fluid (usually blood) in the peritoneal, pericardial, and pleural space; its critical relevance here is identifying peritoneal blood in RAAA patient, at bedside in the emergency room (American Institute of Ultrasound in Medicine and American College of Emergency Physicians. J Ultrasound Med 33(11):2047–2056, 2014).