"Chronic-contained" ruptured abdominal aortic aneurysm: is it real?

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Abdominal Aortic Aneurysm

Background:

• Abdominal aortic aneurysm (AAA) rupture is a surgical emergency.
• Classic diagnostic signs include pain, shock, and a pulsatile mass.
• Diagnosis can be difficult in cases with atypical or chronic presentations.

Observation:

• This report details two patients with a history of "contained chronic" rupture of an abdominal aortic aneurysm.
• These patients presented with symptoms that obscured the diagnosis.
• Rupture occurred months prior to surgical intervention.

Findings:

• Computed tomography (CT) scans are crucial for non-invasive diagnosis in patients with confusing abdominal symptoms.
• The study identifies rare instances of "contained chronic" rupture, distinct from acute leaks.
• Delayed diagnosis was associated with chronic, less palpable aneurysms.

Implications:

• CT imaging should be considered for patients with unexplained abdominal pain and suspected aneurysms.
• Recognition of chronic contained rupture improves diagnostic accuracy and patient outcomes.
• This challenges the typical presentation of AAA rupture, expanding clinical awareness.