Pseudoaneurysm vs True Aneurysm

Differences Between a Pseudoaneurysm and a True Aneurysm

True Aneurysm

A localized dilation of an artery involving all three layers of the vessel wall: intima, media, and adventitia.

Pseudoaneurysm (False Aneurysm)

A contained rupture of the arterial wall where blood leaks out and is held by surrounding tissues, not by the full vessel wall layers.

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Pathophysiology

True Aneurysm

Vessel wall weakens → gradual dilation

Wall structure remains intact

Common in chronic conditions

Pseudoaneurysm

Disruption of vessel wall → blood escapes

Forms a pulsatile hematoma communicating with artery

Wall is formed by fibrous tissue or surrounding structures

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Structural Difference

Feature True Aneurysm Pseudoaneurysm

Vessel wall layers All 3 layers intact Not intact

Wall composition Native arterial wall Surrounding tissue / thrombus

Neck Broad Narrow neck

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Common Causes

True Aneurysm

Atherosclerosis (most common)

Hypertension

Connective tissue disorders (e.g., Marfan syndrome)

Degenerative changes

Pseudoaneurysm

Trauma

Iatrogenic (post catheterization, procedures)

Infection

Surgical complications

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Common Sites

True Aneurysm

Abdominal aorta (AAA)

Thoracic aorta

Popliteal artery

Pseudoaneurysm

Femoral artery (post catheterization)

Radial artery

Anastomotic surgical sites

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Clinical Features

True Aneurysm

Often asymptomatic

May present as pulsatile mass

Risk of rupture if large

Pseudoaneurysm

Painful, tender swelling

Pulsatile mass with bruit

Rapid expansion more common

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Imaging Findings

True Aneurysm

Uniform dilation

Intact vessel wall

No “neck”

Pseudoaneurysm

“Yin-yang sign” on Doppler

Narrow neck connecting to artery

To-and-fro flow pattern

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Complications

True Aneurysm

Rupture

Thrombosis

Embolization

Pseudoaneurysm

Rupture (higher acute risk)

Compression of nearby structures

Infection

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Management

True Aneurysm

Surveillance if small

Surgical repair or EVAR if large or symptomatic

Pseudoaneurysm

Ultrasound-guided compression

Thrombin injection

Surgical repair if unstable

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Key Exam Pearls

True aneurysm = all vessel wall layers involved

Pseudoaneurysm = contained rupture with narrow neck

Yin-yang sign → classic for pseudoaneurysm

Post-procedure pulsatile swelling → think pseudoaneurysm

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One-Line Summary

True aneurysm is a dilated intact vessel, while pseudoaneurysm is a contained arterial rupture outside the vessel wall.

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