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INTERNATIONAL JOURNAL OF CLINICAL AND MEDICAL CASES (ISSN:2517-7346)

A Case Report of Contained Rupture with Pseudo Aneurysm Formation- A Rare Entity

Lokesh Rana1* , Preyender Thakur2, Pooja Gurnal3, Sudir Yadav4, Inderjeet Chauhan4, Padam Negi4, Akshay Sharma4, Tanay raghuvanshi

1 Assistant Professor, Department of Radio-diagnosis, Dr RPGMC, Kangra at Tanda, Himachal Pradesh, India
2 Assistant Professor, Department of Endocrinology, Dr RPGMC, Kangra at Tanda, Himachal Pradesh, India
3 Senior resident, Department of Anaesthesia,  DRPGMC, Kangra at Tanda, Himachal Pradesh, India
4 Resident, Department of radiodiagnoisis, DRPGMC, Kangra at Tanda, Himachal Pradesh, India

CitationCitation COPIED

Rana L, Thakur P, Gurnal P, Yadav S, Chauhan I, et al. A Case Report of Contained Rupture with Pseudo Aneurysm FormationA Rare Entity. Int J Clin Med Cases. 2020 Jan;3(2):130

© 2020 Rana L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 international License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A 66 year old male presenting with chest pain and shortness of breath gradually increasing for past 2 months, CECT was done which shows presence of contained rupture of arch of aorta with pseudo aneurysm formation.

Case Report

We present a case of a 66 year old male presenting with chest pain and shortness of breath gradually increasing for past 2 months CECT images shows aortic aneurysm in ascending and arch with peri-aortic soft tissue with focal discontinuity in the intimal wall calcification with formation of saccular pseudo aneurysm. There is also presence of pericardial effusion and bilateral pleural effusion. VR images also denote the same. Diagnosis is contained rupture with pseudo aneurysm formation. Such entity was rare to be encountered in day to day practice (Figure 1).

A 66 year old male presenting with chest pain and shortness of breath gradually increasing for past 2 months CECT images shows aortic aneurysm(black arrow) in ascending and arch with peri-aortic soft tissue with focal discontinuity in the intimal wall calcification with formation of saccular pseudoaneurysm (white arrow). There is also presence of pericardial effusion and bilateral pleural effusion. VR images also denote the same. Diagnosis is contained rupture with pseudo aneurysm formation.

Discussion

Contained rupture with pseudo aneurysm formation Rupture of thoracic aorta is an emergency requiring immediate diagnosis and management; however contained rupture diagnosis is often delayed due to chronicity and atypical clinical presentation [1,2].

Clinical presentation

Patients usually present with chest pain however symptoms are sometimes masked.

Presenting age is 60-70 years with slight male predominance, concomitant hypertension, CAD and PVD are present in most cases [3-5].

Key imaging diagnostic clues [1,4-6]

  1. Decreased thrombus to lumen ratio
  2. Focal discontinuity of intimal calcification
  3. Tangential calcium sign
  4.  Periaortic stranding

Differentials

  • Non-ruptured aneurysm-Increased thrombus to lumen ratio, Intact intimal calcification
  • Ruptured aneurysm-Along with diagnostic features of contained rupture additional Features are extravasation of contrast, high attenuating crescent and draped aorta 


Figure 1: A 66 year old male presenting with chest pain and shortness of breath gradually increasing for past 2 months CECT images shows aortic aneurysm (black arrow)