DR.

MUHAMMAD HAMMAD
RADIOLOGY DEPARTMENT
AYUB TEACHING HOSPITAL
ABBOTTABAD
 SCENARIO
 A 57-year-old man presented for evaluation of an
abdominal aortic aneurysm, noted incidentally and
diagnosed previously. The man was experiencing no
symptoms. He smoked one to two packs of cigarettes a
day. He had never had surgery. CT Aortogram was
performed.
FINDINGS :-
 Fusiform shaped dilatation of abdominal aorta below
the origin of renal arteries was noted which was
extending up to the bifurcation of abdominal aorta.
 Maximum transverse diameter of this fusiform shaped
dilatation was 4.3 cm and length was 9 cm
approximately.
 The dilatation was not extending into any of the
branches of abdominal aorta and there was no leakage
of contrast into the surrounding area of this dilatation.
 IMPRESSION
 The findings were suggestive of Fusiform Abdominal
Aortic Aneurysm.
ABDOMINAL AORTIC ANEURYSMS
 Abdominal aortic aneurysms (AAA) are focal
dilatations of the abdominal aorta measuring 50%
greater than the proximal normal segment, or >3 cm in
maximum diameter.
Epidemiology
 represent the tenth most common cause of death
 prevalence increases with age
 ~10% patients older than 65 have an AAA
 males are much more commonly affected than females
(4:1 male/female ratio)
Clinical presentation
 Since most AAAs are asymptomatic unless they leak or
rupture, they are commonly diagnosed incidentally
during imaging for other indications.
Etiology
 atherosclerosis (most common)
 inflammatory abdominal aortic aneurysm
 chronic aortic dissection
 vasculitis
 connective tissue disorders
 Marfan syndrome
 Ehlers-Danlos syndrome
 mycotic aneurysm
Associations
 common iliac artery (CIA) aneurysm
 AAA extends into the common iliac arteries in 25% of cases
 the vast majority of patients with CIA aneurysms have an
AAA
 isolated CIA aneurysms are rare
 popliteal artery aneurysm
 4% of patients with an AAA have a peripheral femoral
or popliteal artery aneurysm
 30-50% of patients with a popliteal artery aneurysm have an
AAA
 intracranial cerebral aneurysm
 prevalence of ~10%, higher in females
Radiographic
features
Role of imaging
 detection of AAA
 monitoring of growth rate
 preoperative planning
 postoperative follow-up
Plain radiograph
 An aneurysm may be visible as an area of curvilinear
calcification in the paravertebral region on either
abdominal or lumbar spine radiographs.
 Although not adequate for AAA detection or follow-
up, x-ray may be sufficient for initial detection and
diagnosis.
Inccidental finding of a heavily calcified infra-renal
aortic aneurysm on the plain x-ray images that were
undertaken for back pain. No lumbar fracture or
listhesis can be seen.
This image of a contrast enhanced CT shows the
infrarenal calcified aortic aneurysm. A wall
adherent thrombus can be seen.
Ultrasound
 Ultrasound is optimal for general AAA screening and
surveillance
 Although excellent for following lesions, ultrasound
does not provide sufficient detail for procedural
planning or more complex lesions.
SONOGRAPHIC APEARANCE OF THE
NORMAL AORTA: TRANSVERSE
Mid portion Bifurcation
Large fusiform AAA

SAEM 17
CT
 CT angiography (CTA) is considered the gold standard
for evaluation
 It is excellent for pre-operative planning as :-
1- it accurately delineates the size and shape of
the AAA
2- and its relationship to branch arteries and the
aortic bifurcation.
CTA demonstrates a large infrarenal aortic aneurysm
without evidence of rupture.
CTA shows mild enhancement of the thrombus
in the aneurysm, so-called "dense rim sign"
which is frequently seen in case of a pending
rupture
MR angiography
 Offers lack of ionising radiation, but is more costly,
less widely available, and the examination is
substantially lengthier.
Management options include:
 surveillance
rate of aneurysm growth enlargement in transverse
diameter ≥5 mm in 6 months may be an indication for
intervention

 endovascular aneurysm repair (EVAR)

 Surgery
THANK YOU