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Aortic rupture refers to a full-thickness tear of the aortic wall, resulting in extravasation of blood into adjacent compartments (mediastinum, pleural space, or peritoneum).

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It is often rapidly fatal without emergent diagnosis and intervention.

Classification

Types of Aortic Rupture

Type Description
Traumatic rupture Sudden deceleration injury (e.g., motor vehicle accident)
Spontaneous rupture Rupture of an aneurysm, dissection, or penetrating ulcer
Iatrogenic Post-catheterization or surgical manipulation
Contained rupture (leak) Periaortic hematoma without free extravasation (transiently stable)

Common locations:

Mechanism Most Common Site
Traumatic Aortic isthmus (just distal to LSA)
Aneurysmal rupture Infrarenal abdominal aorta, thoracic aneurysms
Dissection-related Ascending or descending thoracic aorta

Clinical presentation

Feature Details
Chest/back/abdominal pain Sudden, severe, tearing
Hypotension / shock From blood loss; may be initial sign
Pulsatile mass Suggests AAA rupture
Syncope, cardiac arrest Especially in ascending aortic rupture (tamponade)
Neurologic signs Spinal cord ischemia, stroke (if arch involved)

Radiology

CT Angiography (CTA) –

Key Findings Implications
Periaortic hematoma Hyperdense crescent or irregular soft tissue around aorta
Active contrast extravasation Bright contrast leaking outside the aortic lumen
Aortic wall disruption or contour irregularity Direct sign of rupture
Hemothorax / hemoperitoneum High-density fluid indicating blood
Draped aorta sign (chronic leak) Posterior wall indistinct, conforming to spine

Key Radiologic Signs

Sign Description
Periaortic hematoma Hyperdense crescent around aorta (non-enhanced CT)
Active extravasation Contrast leaks into surrounding soft tissue on arterial phase CT
Draped aorta sign Posterior aortic wall lost, closely follows vertebral body
Hemothorax / hemoperitoneum High-attenuation fluid in pleural or peritoneal cavity
Loss of aortic contour Suggests wall disruption or pseudoaneurysm

Differentials