A contained rupture presenting as a vascular cavity after an aortic graft is most consistent with which complication?

• A. Aneurysm
• B. Pseudoaneurysm
• C. Hematoma
• D. Embolism

Answer: (B)

This question tests recognizing a pseudoaneurysm. After an aortic graft, a contained rupture forms a sac that communicates with the graft lumen, but the rupture is held by surrounding tissue rather than the vessel wall itself. That creates a false aneurysm—a vascular cavity bounded by adjacent structures rather than all three layers of the vessel wall. On ultrasound you’d expect a pulsatile sac connected to the graft with a neck showing to-and-fro flow on Doppler (the yin-yang pattern can also be seen within the sac). This differs from a true aneurysm, which is dilation of the vessel wall itself without a discrete rupture and cavity; a hematoma is a noncommunicating blood collection around the graft; and an embolism causes downstream occlusion rather than a contained cavity.