Hidden in Plain Sight: Unmasking a Pseudoaneurysm Without Contrast

Area of Science:

• Vascular imaging
• Radiology
• Cardiovascular medicine

Background:

• Pseudoaneurysms involve one or two arterial wall layers, distinct from true aneurysms affecting all three.
• CT angiography is standard for aortic pseudoaneurysms, but contrast agents pose risks for patients with renal insufficiency.
• Magnetic resonance (MR) imaging offers a contrast-free alternative for vascular assessment.

Purpose of the Study:

• To evaluate the utility of contrast-enhanced MR imaging in diagnosing aortic pseudoaneurysms.
• To demonstrate the effectiveness of specific MR sequences in characterizing pseudoaneurysms.
• To highlight MR's role in managing patients with contraindications for contrast media.

Main Methods:

• Utilized T2w True Fast Imaging with Steady-State Free Precession (TRUFI) and T1 Dixon sequences.
• Performed MR imaging on a patient with severe renal insufficiency and an incidental aortic lesion.
• Focused on characterizing the lesion and differentiating it from other pathologies.

Main Results:

• MR imaging accurately characterized the pseudoaneurysm without contrast administration.
• The technique successfully ruled out other vascular findings like intramural hematoma.
• Mediastinal lesions, including undifferentiated pleomorphic sarcoma, were excluded.

Conclusions:

• Contrast-enhanced MR imaging is a viable alternative for diagnosing aortic pseudoaneurysms in patients with renal impairment.
• Specific MR protocols enable precise characterization of pseudoaneurysms, guiding clinical management.
• This case underscores the diagnostic power of non-contrast MR in complex vascular assessments.