CTICasesContained Rupture of Descending Aortic Aneurysm (with Thrombus Fissuration Sign)
Imaging findings
Contrast-enhanced CT demonstrates a large descending thoracic aortic aneurysm associated with a large, adjacent left lower lobe mass-like consolidation. Crucially, there is an acute, pointed fissure of contrast material extending deep into the mural thrombus of the aneurysm, which is contiguous with the hematoma invading the left lower lobe. An MRI confirms that the mass-like consolidation is in continuity with the aortic adventitia.
Key takeaways
Aortic aneurysms can rupture into the adjacent lung parenchyma, presenting as a "lung mass" and massive hemoptysis, which can be misdiagnosed as lung cancer invading the aorta. The "thrombus fissuration sign" on contrast-enhanced CT, characterized by an acute angle of contrast extending into the mural thrombus, is a highly specific sign of impending or contained rupture, indicating that blood has dissected through the thrombus to the outer wall.
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