Arrivé L, Mehdi M, Monnier-Cholley L, Rotenberg L, Ladeb M F, Tubiana J M
Service de Radiologie, Hôpital Saint-Antoine, PARIS.
Ann Radiol (Paris). 1996;39(2):78-88.
Ruptured abdominal aortic aneurysm is the major surgical emergency in the retroperitoneal compartment. Rupture of an abdominal aortic aneurysm is always fatal without urgent operative repair. Computed tomography is the reference standard for the diagnosis of ruptured abdominal aortic aneurysm in hemodynamically stable patients. At CT, the diagnosis is based on the combination of abdominal aortic aneurysm and extraluminal retroperitoneal blood. Retroperitoneal hemorrhage usually demonstrates both isodense and hyperdense areas. In most cases hemorrhage is located in psoas compartments and perirenal space. In the case of ruptured abdominal aortic aneurysm other findings may be demonstrated such as focal interruption of the aortic wall and active extravasation of contrast media in the retroperitoneal compartments. Inflammatory abdominal aortic aneurysm, that may present as acute abdominal pain, should be recognized and differentiated from ruptured abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm is characterized by a fibrotic process around the abdominal aorta that may entrap adjacent structures such as ureters, duodenum and inferior vena cava. Aortic dissection, mycotic aneurysm, and inferior vena cava thrombosis are less common. Complications occurring after emergency aneurysm replacement are also considered.
腹主动脉瘤破裂是腹膜后腔的主要外科急症。腹主动脉瘤破裂若不紧急手术修复往往致命。计算机断层扫描是血流动力学稳定患者腹主动脉瘤破裂诊断的参考标准。在CT上，诊断基于腹主动脉瘤和腔外腹膜后血肿的结合。腹膜后出血通常表现为等密度和高密度区域。多数情况下，出血位于腰大肌间隙和肾周间隙。腹主动脉瘤破裂时，还可能出现其他表现，如主动脉壁的局灶性中断以及腹膜后腔对比剂的活动性外渗。炎性腹主动脉瘤可能表现为急性腹痛，应予以识别并与腹主动脉瘤破裂相鉴别。炎性腹主动脉瘤的特征是腹主动脉周围的纤维化过程，可包绕相邻结构，如输尿管、十二指肠和下腔静脉。主动脉夹层、感染性动脉瘤和下腔静脉血栓形成较少见。还考虑了紧急动脉瘤置换术后发生的并发症。
