Radiologic features and anatomic basis of atypical clinical presentations of ruptured abdominal aortic aneurysms

Ruptured abdominal aortic aneurysms (AAAs) occasionally manifest with atypical clinical presentations and can be initially misdiagnosed. Symptoms are attributable either to local mass effect from the aneurysm or a contained rupture, or to the particular cavity or anatomic space into which an aneurysm bleeds. Radiologic studies obtained in this patient population often will demonstrate signs of the ruptured AAA, and these signs should be actively searched for when a ruptured AAA can be in the differential diagnosis. Emergent computed tomographic examination is indicated to confirm any clinical or radiologic suspicion of a ruptured abdominal aortic aneurysm, provided that the patient remains hemodynamically stable. The anatomic basis for a ruptured AAA presenting clinically as renal colic is discussed and illustrated, and the spectrum of clinical presentations of ruptured AAAs is reviewed.