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Abdominal Aortic Aneurysm
Suvranu Ganguli, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Abdominal aortic aneurysm (AAA)
          • Definitions

            • Abdominal aortic aneurysm
              • Fusiform or saccular enlargement of aorta ≥ 1.5x normal diameter (> 3 cm in abdominal aorta)
              • AAA is described by its relationship to renal arteries
                • Infrarenal: > 1 cm of normal aorta below renal arteries
                • Juxtarenal: Begins within 1 cm of renal arteries
                • Suprarenal: Extends above renal arteries
              • Inflammatory aneurysm: Uninfected AAA with enhancing circumferential inflammatory tissue
                • 5% of AAA
                  • Abdominal pain may mimic rupture
                • Adjacent structures (e.g., duodenum) involved
              • Mycotic aneurysm
                • Misnomer because any infectious agent may be underlying cause
                • Rare but associated with high mortality
                • Primary = direct extension from adjacent infection
                • Secondary = embolic (endocarditis)
                • Cryptogenic = seeding during septicemia
                • Salmonella, Staphylococcus aureus, Streptococci
            • Endovascular aneurysm repair (EVAR): Placement of intravascular endograft to bridge aortoiliac segments and depressurize AAA
            • Endoleak: Persistent flow of blood outside endograft

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        • Nuclear Medicine Findings

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Jackson RS et al: Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA. 307(15):1621-8, 2012
                                                2. Sommer WH et al: Time-resolved CT Angiography for the Detection and Classification of Endoleaks. Radiology. 263(3):917-26, 2012
                                                3. Thawait SK et al: Group B streptococcus mycotic aneurysm of the abdominal aorta: report of a case and review of the literature. Yale J Biol Med. 85(1):97-104, 2012
                                                4. Walker TG et al: Image optimization during endovascular aneurysm repair. AJR Am J Roentgenol. 198(1):200-6, 2012
                                                5. Truijers M et al: Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance. J Cardiovasc Surg (Torino). 50(4):423-38, 2009
                                                6. Lin MP et al: A comparison of computed tomography, magnetic resonance imaging, and digital subtraction angiography findings in the diagnosis of infected aortic aneurysm. J Comput Assist Tomogr. 32(4):616-20, 2008
                                                7. Blankensteijn JD et al: Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 352(23):2398-405, 2005
                                                8. Eickhoff JH: Incidence of diagnosis, operation and death from abdominal aortic aneurysms in Danish hospitals: results from a nation-wide survey, 1977-1990. Eur J Surg. 159(11-12):619-23, 1993
                                                9. LaRoy LL et al: Imaging of abdominal aortic aneurysms. AJR Am J Roentgenol. 152(4):785-92, 1989
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Abdominal aortic aneurysm (AAA)
                                                        • Definitions

                                                          • Abdominal aortic aneurysm
                                                            • Fusiform or saccular enlargement of aorta ≥ 1.5x normal diameter (> 3 cm in abdominal aorta)
                                                            • AAA is described by its relationship to renal arteries
                                                              • Infrarenal: > 1 cm of normal aorta below renal arteries
                                                              • Juxtarenal: Begins within 1 cm of renal arteries
                                                              • Suprarenal: Extends above renal arteries
                                                            • Inflammatory aneurysm: Uninfected AAA with enhancing circumferential inflammatory tissue
                                                              • 5% of AAA
                                                                • Abdominal pain may mimic rupture
                                                              • Adjacent structures (e.g., duodenum) involved
                                                            • Mycotic aneurysm
                                                              • Misnomer because any infectious agent may be underlying cause
                                                              • Rare but associated with high mortality
                                                              • Primary = direct extension from adjacent infection
                                                              • Secondary = embolic (endocarditis)
                                                              • Cryptogenic = seeding during septicemia
                                                              • Salmonella, Staphylococcus aureus, Streptococci
                                                          • Endovascular aneurysm repair (EVAR): Placement of intravascular endograft to bridge aortoiliac segments and depressurize AAA
                                                          • Endoleak: Persistent flow of blood outside endograft

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Angiographic Findings

                                                                    • Imaging Recommendations

                                                                      • Nuclear Medicine Findings

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Gross Pathologic & Surgical Features

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Jackson RS et al: Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA. 307(15):1621-8, 2012
                                                                                              2. Sommer WH et al: Time-resolved CT Angiography for the Detection and Classification of Endoleaks. Radiology. 263(3):917-26, 2012
                                                                                              3. Thawait SK et al: Group B streptococcus mycotic aneurysm of the abdominal aorta: report of a case and review of the literature. Yale J Biol Med. 85(1):97-104, 2012
                                                                                              4. Walker TG et al: Image optimization during endovascular aneurysm repair. AJR Am J Roentgenol. 198(1):200-6, 2012
                                                                                              5. Truijers M et al: Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance. J Cardiovasc Surg (Torino). 50(4):423-38, 2009
                                                                                              6. Lin MP et al: A comparison of computed tomography, magnetic resonance imaging, and digital subtraction angiography findings in the diagnosis of infected aortic aneurysm. J Comput Assist Tomogr. 32(4):616-20, 2008
                                                                                              7. Blankensteijn JD et al: Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 352(23):2398-405, 2005
                                                                                              8. Eickhoff JH: Incidence of diagnosis, operation and death from abdominal aortic aneurysms in Danish hospitals: results from a nation-wide survey, 1977-1990. Eur J Surg. 159(11-12):619-23, 1993
                                                                                              9. LaRoy LL et al: Imaging of abdominal aortic aneurysms. AJR Am J Roentgenol. 152(4):785-92, 1989