Unstable abdominal aortic aneurysms: a review of MDCT imaging features

Abdominal aortic aneurysms are commonly encountered during abdominal CT imaging, and size-based parameters for surgical or endovascular repair are well established. Aneurysms greater than 5 cm in diameter are recognized as representing an increased rupture risk and meriting intervention. Increasingly, additional interest has been generated in recognizing imaging features which may herald instability and portend a higher chance for potentially catastrophic rupture. This article will review and illustrate such signs, including hyperattenuation of mural thrombus, rapid expansion, low thrombus to lumen ratio, intimal calcification disruption, posterior mural draping, and saccular outpouching. Other features of complicated abdominal aneurysms including perianeurysmal inflammation, aortocaval and aortoenteric fistula formation will also be addressed. Heightened awareness of these features and their prognostic implications, as well as timely communication with the clinical service, is critical for the interpreting radiologist