Pseudoaneurysm

Definition

A pseudoaneurysm is a false aneurysm in that its walls do not contain intact components of the aortic wall. The histopathology of the walls of a pseudoaneurysm, are made from hematoma or fibrous tissue rather than the expanded intima media and adventitia of a true aneurysm.

Causes include trauma, and infection. When the pseudoaneurysm is caused by infection it is called a mycotic pseudoaneurysm.

The pseudoaneurysm is usually eccentric in location, and has a relatively narrow neck.

There is a significantly higher predisposition to rupture and hence treatment is considered urgent, particularly if there is pain and signs of inflammation such as a fever or elevated white count.

Irregular Saccular Pseudoaneurysm

35290 Courtesy of Laura Feldman MD. code aneurysm aorta artery pseudoaneurysm thorax trauma

Saccular Pseudoaneurysm

This image represents an LAO view of the thoracic aorta in a 38 year old patient, 13 years after an MVA. There is an aneurysmal bulge at the level of the isthmus, representing a trumatic aneurysm at the characteristic location of the ligamentum arteriosum. 35178 Courtesy of Laura Feldman MD. code CVS aorta artery thorax trauma

Aortic Laceration, Pseudoaneurysm, Mediastinal Hematoma, and Hemothorax

17540c02 thorax thoracic aorta isthmus aortic laceration pseudoaneurysm leak contained rupture posterior mediastinal hematoma pleura pleural effusion hemothorax aortic laceration trauma traumatic tear trauma MVA CTscan Courtesy Ashley Davidoff MD 17536b01 17537 17538 17539 17540 17540c01 17540c02

Aortic Laceration, Pseudoaneurysm, Site of the Rupture

17540c01 thorax thoracic aorta isthmus aortic laceration pseudoaneurysm leak contained rupture posterior mediastinal hematoma pleura pleural effusion hemothorax aortic laceration trauma traumatic tear trauma MVA CTscan Courtesy Ashley Davidoff MD 17536b01 17537 17538 17539 17540 17540c01 17540c02

Mycotic Aneurysm

hx 68F with previous aortic surgery p/w back pain and fever aorta descending thoracic, thoracoabdominal fx periaortic fluid collection fx false aneurysm fx pseudoaneurysm fx paravertebral fluid collection bone vertebral body destruction dx mycotic aneurym with dx vertebral osteomyelitis CTscan

Courtesy Ashley Davidoff MD 44502

Mycotic Aneurysm

Courtesy Ashley Davidoff MD 44502c02

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

Enlarging Pseudoaneurysm

44508 hx 68M p/w asymptomatic February 2004 abdomen abdominal aorta fx pseudoaneurysm fx 5.6 by 5cms dx false aneurysm

44514 hx 69M follow up July 2005 abdomen abdominal aorta fx pseudoaneurysm dx false aneurysm fx 6.6 by 6.2cms dx enlarging pseudoaneurysm CTscan Courtesy Ashley Davidoff MD