CTICasesLeaking Thoracic Aortic Aneurysm
Imaging findings
Non-contrast and contrast-enhanced chest CT show a large saccular aneurysm of the descending thoracic aorta. The aneurysm demonstrates the 'draped aorta' sign, closely abutting the anterior surface of the thoracic spine. There is high-density crescentic thickening in the aneurysm wall (intramural hematoma) and an adjacent extrapleural fluid collection (extrapleural hematoma) tracking along the left diaphragm, indicating a contained rupture.
Key takeaways
A leaking or ruptured thoracic aortic aneurysm is a cardiovascular emergency. CT signs of contained or impending rupture include the 'draped aorta' sign (where the posterior wall of the aorta conforms to the shape of the adjacent vertebral body), high-attenuation intramural hematoma, and extrapleural or mediastinal hematoma. Rapid surgical or endovascular repair (TEVAR) is required to prevent catastrophic exsanguination.
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