From impending to rupture: a case of imaging challenges in abdominal aneurysm diagnosis

Background: Abdominal Aortic Aneurysm (AAA) is defined as a permanent dilation of the artery with a lumen diameter at least 50% larger than the proximal normal segment. Risk factors for AAA include advanced age, male gender, smoking history, hypertension, and a family history of AAA. AAA remains a leading cause of mortality in the United States due to aneurysm rupture. This study aims to highlight the role of radiological imaging in the management of AAA cases. Case Presentation: A 70-year-old man initially presented with a lump near the umbilical region. One year later, he returned to the hospital complaining of severe abdominal pain in the same area. The initial thoracoabdominal CT angiography revealed an AAA with signs of impending rupture. A subsequent CT scan performed one year later confirmed a ruptured aneurysm. Conclusion: Radiological imaging, particularly CT angiography, is critical in the diagnosis and pre-operative assessment of AAA. Key imaging findings include aneurysm size, length, morphology, location, presence of atherosclerosis, intraluminal thrombus, and features indicating aneurysm instability. These parameters are essential for guiding clinical decision-making and optimizing patient outcomes.