Clinical Presentation and Diagnosis of Ruptured Aneurysms

Symptom Profile

The European Society of Cardiology recommends immediate evaluation for life-threatening hemorrhage in patients presenting with acute onset of severe pain—in the chest/back for thoracic aneurysms or abdomen/back/flank for abdominal aneurysms 1, 2, 3
Abdominal aortic aneurysm (AAA) rupture presents with acute abdominal, back, or flank pain in 65-90% of cases 3
Thoracic aortic aneurysm rupture manifests as acute chest and/or back pain, with concurrent abdominal pain possible in thoracoabdominal aneurysms 1
Pain may radiate to the groin in AAA rupture 2
Recurrent or refractory pain identifies patients at highest risk of progression from contained to complete rupture 1, 3

CT Angiography has a sensitivity of 91.4% and specificity of 93.6% for diagnosing AAA rupture 3
Periaortic stranding or soft tissue changes indicate rupture 3
Contrast extravasation confirms active bleeding and complete rupture 3
Intramural hematoma on non-contrast phase signals impending rupture 1, 3
Pleural or peritoneal effusions, especially if increasing, indicate contained or complete rupture 1, 3
Perivascular hematoma sealed by retroperitoneal structures defines contained rupture 1, 3

Contained rupture is characterized by hemodynamic stability, preserved aortic wall integrity on imaging, and sealed hemorrhage 1, 3
Free rupture is characterized by hemorrhagic shock, massive hematoma, and rapid progression to death 1
Impending rupture is characterized by acute pain with preserved wall integrity but intramural changes on imaging 1, 3

Hypertension is present in nearly all cases of aneurysm rupture 5
Tobacco use is a risk factor for aneurysm rupture 4
Female sex is a risk factor for rupture, which occurs at smaller diameters 2, 4
Familial predisposition and connective tissue disorders are also risk factors for aneurysm rupture 4