Chronic contained rupture of abdominal aortic aneurysm (draped aorta sign) with vertebral erosion
Presentation
Known abdominal aortic aneurysm, treated conservatively. Noted larger size of aneurysm on ultrasound.
Patient Data
Large fusiform aneurysmal dilatation of the infrarenal abdominal aorta extending to the bifurcation and proximal right common iliac artery with eccentric mural thrombus seen within. There is draping of the posterior wall of aorta onto both sides of L2-L3 vertebrae with loss of fat plane as well as bony erosion and sclerotic changes of the anterior vertebral body of L3. No contrast extravasation to suggest active bleed. No significant periaortic fat stranding.
Cholelithiasis. No biliary dilatation.
Absent left kidney with surgical clips at this region in keeping with previous left nephrectomy. Right midpole renal cortical cyst.
Diffuse thickening of the stomach wall. Small right inguinal hernia with small bowel content.
Several lung nodules in the visualized lung bases.
Chronic compression fracture of T11.
Case Discussion
Draped aorta sign is a CT finding where the posterior wall of the dilated aorta follows the vertebral contour with loss of fat plane in between. It has been described as a sign suggestive of a contained leak in aortic aneurysms 1. In this case, there was also associated vertebral erosion which had well-corticated and sclerotic margins, likely due to repetitive pressure from aortic pulsations 2.
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