Case history
Case history #1
A 65-year-old man presents to his local aneurysm surveillance team for a screening ultrasound scan. He has been feeling well and in his usual state of good health. His medical history is notable for mild hypertension and he has a 100-pack-year smoking history. On ultrasound an infrarenal AAA is identified.
Case history #2
A 55-year-old man with a history of hypertension (well controlled with medication) and cigarette smoking presents to his general practitioner with a 2-day history of constant and gnawing epigastric pain. The pain has been steadily worsening in intensity. He says the pain radiates to his lower back and both groins at times. There is a palpable pulsatile mass just left of midline above the umbilicus. He is immediately referred to a regional vascular service for definitive management, but during transfer becomes hypotensive and unresponsive.
Other presentations
The triad of abdominal pain, weight loss, and elevated erythrocyte sedimentation rate suggests inflammatory AAA.[3][7] A tender, palpable pulsatile epigastric mass on examination and elevated C-reactive protein may also be present.[3] Abdominal or back pain with fever is suggestive of infectious AAA.[3] Typically there is a history of arterial trauma, intravenous drug misuse, local or concurrent infection, bacterial endocarditis, or impaired immunity. There may be associated osteomyelitis of the thoracic or lumbar spine. Anaemia, leukocytosis, and positive blood cultures are common.[12] A patient may also present with complications of unruptured aneurysms, including distal embolisation, acute thrombosis, or symptoms caused by ureterohydronephrosis.[3][13]
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