• Images in cardiology

Rupture of an aortic aneurysm can place the patient in a critical state. However, it is extremely difficult to know the point of rupture before surgery. We succeeded in indicating the rupture line of an ascending aortic aneurysm by image reconstruction using data from a spiral scan by computed tomography (CT).

An 84 year old woman was admitted for cardiac tamponade following the rupture of an ascending aortic aneurysm. Conventional CT revealed an eccentric high density ring in the neck of an atherosclerotic fusiform aneurysm in the ascending aorta. This ring could not differentiate the periaortic haematoma from the thrombosed type of acute aortic dissection. The multiplanar reformation, which was obtained from late enhancement of the aorta with contrast materials, depicts a hairbreadth projection (arrow) extending across the adventitia of the aorta. We can see from three dimensional reformation that this hairbreadth projection (arrow) is positioned beside the shoulder of the calcification (asterisk) of the neck of the aneurysm. These images indicate that the brittle wall near the calcification was torn and penetrated by shear stress.

This diagnostic technique and these findings might be useful for the qualitative diagnosis of rupture, which has been difficult to make from images despite the critical state of the patients.