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?