Aneurysm

Jessica Humphries

Definition

Aneurysmal disease is a circulatory disease that is characterized by the abnormal expansion of blood vessel walls to form an aneurysm.

The causes of aneurysmal disease include atherosclerosis (most commonly), aortic dissection, trauma, medial degeneration, and infection.

The primary result of aneurysmal disease is the formation of an aneurysm, which, in turn, may result in a pulsating feeling, abdominal and back pain, coughing, wheezing, Horner’s syndrome, hoarseness, and difficulty swallowing. Embolic disease results in rare cases.

Common diagnostic procedures for this disease include ultrasound, angiography, and CT and MRI scanning.

Aneurysmal disease is usually treated with surgery to resect the aneurysm(s).

Brain

Large Anterior Communicating Artery Berry Aneurysm

The large rounded contrast filled structure overlaid in red in b, represents a berry aneurysm of the anterior coomunicating artery not on this angiogram of the left internal carotid artery.

16004c01 intracerebral artery anterior communicating artery berry aneurysm angiogram angiography Courtesy Ashley Davidoff MD

Large Anterior Communicating Artery Berry Aneurysm

The large rounded contrast filled structure overlaid in red in b, represents a berry aneurysm of the anterior coomunicating artery noted on this CT and correlating with the angiogram above.

16006c01 intracerebral artery anterior communicating artery enhancing mass berry aneurysm CTscan Courtesy Ashley Davidoff MD 16004c01

Heart

Normal Left Atrial Appendage and Aneurysm of LAA

70025d01 heart cardiac left atrium LA left atrial appendage fx enlarged fx aneurysmal dx aneurysm of the left atrial appendage CTscan Davidoff MD

Aneurysm of the Left Atrial Appendage

49760c01.800 34 year old female presents with atrial flutter heart cardiac left atrium LAA left atrial appendage size enlarged dx aneurysm of the left atrial appendage partial absence of the pericardium MRI Davidoff MD

Aortic Aneurysms

Sinus of Valsalva Aneurysm Marfan’s Syndrome

07973.800 heart cardiac right atrium aortic valve aortic sinus fx right atrial filling defect dx sinus of Valsalva aneurysm of the right aortic sinusprolapsing into the right atrium (RA defect) dx Marfan’s Syndrome MRI T1 weighted Davidoff MD 07973.800 07974c01 07974.800

Aneurysm of the Abdominal Aorta

This angiogram of the abdominal aorta shows a widened infrarenal aorta. At first glance the lumen of the aorta appears normal, but a faint curvilinar calcification of the true wall can be seen to the patients left in the first image. The second image (b) reveals the true size of the aneurysm. Courtesy Ashley Davidoff MD 22734 cW02 codeCVS aorta artery abdomen aneurysm AAA

Mycotic Aneurysm with Osteomyelitis

This combination of images from a CTscan of the abdomen are of a middle aged man who presented with back pain and fever, with a remote history of AAA repair. The lateral scout film shows scalloping of vertebral bodies 2 and 3 (a) highighted in green overlay in b. The CTscan with soft tissue windows (c) and bone windows (d) show a complex fluid collection surrounding the aorta which proved to be a perigraft infection. Courtesy Ashley Davidoff MD. 22725c02 code CVS artery aorta abdomen abscess AA repair infection bone vertebra lumbar anterior scalloping

Arteria MAgna AAA with Popliteal Artery Aneurysms

This combination of images from the abdomen, pelvis and popliteal fossa reflect ectatic and aneurysmal disease at multiple sites. This entity is called arteria magna. The aorta in a, is only mildly ectatic, while the right common iliac has a dominant aneurysm, though a prominent aneurysm is noted in the left common iliac. The femoral arteries are moderately aneurysmal, while ther are significant aneurysms in both popliteal fossae. (c,d,e) There has been an acute rupture of the right popliteal aneurysm with an hematocrit level in the contained component of the bleed. (e) Courtesy Laura Feldman MD. 35848c code CVS artery aorta arteria magna aneurysm iliac femoral popliteal rupture

Aortocaval Fistula Caused by Erosion of a AAA into the IVC

This series of digital aortograms shows a rotund fusiform infrarenal aortic aneurysm (a, c – red overlay)) which later in the study shows premaure filling of the IVC (b, d blue overlay). This is an example of aneurysmal erosure of the the IVC and secondary formation of an arteriovenous fistula. Courtesy Laura Feldman MD 35858c03CP code CVS aorta IVC aneurysm AAA AV fistula

Penetrating Ulcer with Rupture

17529c01 artery descending thoracic aorta abdominal aorta dx rupture pseudoaneumysm ulcerating plaque mural hematoma ruptured through aortic wall hemorrhage hematoma retroperitoneum CTscan Courtesy Ashley DAvidoff MD Ashley Davidoff MD

Normal and AAA

11976c01 aorta abdomen abdominal aorta renal afrteries kidney fx normal AAA abdominal aortic aneurysm horseshoe kidney angogram angiography lumbar arteries Davidoff MD

Ascending Aortic Aneurysm

42358.800 aorta fx enlarged MPA pulmonary artery aneurysm of the ascending aorta CTscan Davidoff MD

Dissection

This pathological specimen shows an aortic dissection starting at the root of the aorta and extending across the arch and into the descending portion. The false lumen is filled with clotted blood. Courtesy Henri Cuenoid MD 13421 code CVS thorax AO aorta dissection grosspathology

Pressure Tension Radius Laplace’s Law

This image shows a famous cardiologist, Dr Jonathan Fisher performing as Zippy the clown revealing and exaggerating the difficulty with surface tension and radius in the early stages of blowing up a balloon. Courtesy Ashley Davidoff MD. 60730b01 code lung physiology balloon surface tension surfactant alveolus alveoli radius principles

Normal aorta and Abdominal Aneurysm – Pressure Tension and Laplace’s Law

70027c01 aorta abdomen abdominal aortic aneurysm normal aorta TCV applied biology AAA USscan Davidoff MD

Fusiform Infrarenal AAA

23263b back pain aorta artery abdominal aortic aneursym fusiform shape spine bone MRI T1 sagittal Courtesy James Donnelly MD

AAA 7.4cms – Indications for Surgical Intervention

2055BH~1.c01 abdomen aorta abdominal aorta AAA aneurysm thrombus 7.5cms surgical size Courtesy Philips Medical Systems

Normal and Ruptured Aorta

37004 abdomen aorta kidneys cortical phase subcurtaneous fat adipose tissue normal anatomy gallsones cholelthiasis CT scan Davidoff MD

18269 aorta abdomen AAA aortic aneurysm abdominal aorta retroperitoneum fx retroperitoneal hematoma fx active hemorrhage fx perinephric hematoma anterior pararenal space perirenal space posterior pararenal space hemorrhage dx rupture abdominal aortic aneurysm CTscan Davidoff MD fx ruptured AAA

Surgical repair of 12cms AAA

72460c01 aorta AAA abdomen abdominal aortic aneurysm 12 cms aneurysm surgical exposure retractors surgical exposure control upper inflow with cross clamp control of outflow opening the aoric wall exposing the lumen filled with thrombus operating room treatment delivery of 12cmss thrombus and leaving eptyaortic sac Courtesy Syed Razvi MD

Nervous System – Cerebral Circulation

Aneurysm

20258 brain artery fx mass calcified dx aneurysm CTscan Courtesy Ashley Davidoff MD Uploaded RP

Aneurysm of the Internal Carotid

49411 49409 hx 49 F with headaches artery brain cerebral circulation carotid artery internal carotid fx aneurysm arteriogram arteriography angiogram angiography Davidoff MD Courtesy Ram Chavalli MD 49400, 49401 49402, 49403, 49409, 49410, 49411,49416, 49417, 49418, 49419, 49420, 49421, 49422, 49424

Subarachnoid Bleed – Ruptured Aneurysm

72034c01 59 male presents with headache brain meninges tentorium circle of Willis ambient cisterns Berry aneurysm rupture subarachnoid blood subarachnoid hemorrhage headache CTscan Davidoff MD

MCA clip and MCA infarct s/p aneurysm repair

71542c02 50 M s/p clipping of MCA aneurysm brain middle cerebral artery cerebrum fx clip artifact artifact from subcutaneous V-P shunt a= CTscan b = T2 weighted image c= FLAIR d = GRE fx metallic density GRE T2 star effect MRI Davidoff MD

Coronary Artery Aneurym

Kawasaki Arteritis and Coronary Artery Aneurysm

07587 heart cardiac aneursym coronary artery Kawasaki’s areteritis grosspathology Courtesy Ashley Davidoff MD

Gastrointestinal System

Polyarteritis Nodosa

Occlusive Vascular Disease: Causes of Vascular Occlusion – Polyarteritis Nodosa. This is a medium power photomicrograph from a bowel in a patient with Polyarteritis Nodosa. Bowel is commonly affected in this disorder. The medium sized artery seen here has undergone a deeply eosinophilic (fibrinoid) change. Notice that there is a surrounding inflammatory infiltrate of WBCs and formation of aneurysmal dilatation. This can result in massive hemorrhage if the aneurysm ruptures. colon large bowel artery small bowel fx aneurysm inflammation dx polyarteritis nodosa histopathology Courtesy Barbara Banner MD 12889

Right Gastroepiploic Artery Aneurym

71480.800 UGI bleed artery stomach gastroepiploic artery GDA gastroduodenal artery aneurym angiogram angiography Davidoff MD 71482c01

Right Gastroepiploic Artery Aneurym – Coiled

71482c01 UGI bleed artery stomach gastroepiploic artery GDA gastroduodenal artery aneurym metallic coil embolization MIT angiogram angiography Davidoff MD 71480.800

Splenic Artery Aneurym

Ruptured Aneurysm from Portal Hypertension – Repair by Embolization

22521 22524 Courtesy Ashley Davidoff MD code spleen + artery + dx ruptured splenic artery aneurysm pseudoaneurysm + cystic fibrosis biliary cirrhosis portal hypertension angiography emergency

Femoral Artery Aneurym

Yin Yang Sign of Flow Reversal

60438.800 s/p catheterization with painful pulsatile hematoma with new bruit artery femoral artery fx yin yang sign aka ying yang turbulent flow dx pseudoameurysm false aneurysm USscan color flow doppler red blue Davidoff MD

Pseudoaneurysm (Yin Yang) Before and After Treatment with Thrombin

60447c01 60438.800 s/p catheterization with painful pu;satile hematoma with new bruit artery femoral artery fx yin yang sign turbulent flow dx pseudoameurysm false aneurysm USscan color flow doppler red blue treated with thrombin injection Davidoff MD

References

CT signs of pending Aortic aneurysm rupture web presentation from radiology assistant .nl 5*

Gonsalves crescent sign

Pillari letter to the editor