Missed Aneurysm Noncontrast Head CT

An example of what should not happen — an unruptured aneurysm is missed on a “nonvascular” study — in this case a noncontrast head CT.  Later on the aneurysm ruptures — a human tragedy, aside from all other nonmedical ramifications.    So, pay attention to all reconstructions / projections

An octagenerian presents with SAH

CTA shows typical ACOM aneurysm

A few old CTs are available for review.  Retrospectively, 13 years ago, there is fullness in the ACOM area — only axials are available then

Three months prior to rupture — history of fall (see occipital soft tissue hematoma).   And ACOM fullness again — more so probably

Coronals are more concerning

Sagittal is unmistakable

CTA post rupture and CT 3 mo prior side by side

No question about it.  So, be careful and look at everything.



Now, what if this aneurysm was called 3 months prior — 6 mm in an 80+ year old.  Who would treat?  Who would watch?  Who needs all kinds of additional info about this that and the other? Who is tried of dealing with this problem for years despite having all the info, without being closer to answer?