History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include cigarette smoking, family history, increased age, male sex for prevalence and female sex for rupture, and congenital/connective tissue disorders.
uncommon
palpable pulsatile abdominal mass
Palpate the abdomen to look for a pulsatile epigastric mass in any patient with suspected ruptured or intact AAA. However, be aware that abdominal palpation has a low sensitivity for detection of AAA. Detection rates are affected by aortic diameter, clinician experience, and body habitus of the patient.[3] The sensitivity of abdominal palpation for detecting AAA decreases in patients with an abdominal girth more than 100 cm.[70]
Other diagnostic factors
uncommon
abdominal, flank, or back pain
Patients with ruptured AAA may present with new abdominal and/or back pain.[42] The classic triad of abdominal and/or back pain, hypotension, and a pulsatile abdominal mass is present in about 50% of patients with a ruptured AAA.[3]
Practical tip
Symptoms of ruptured AAA may mimic those of renal colic, especially in older patients.[69]
However, patients with intact AAA are usually asymptomatic and their aneurysm is detected incidentally or through targeted screening.[3] In the minority of patients who experience symptoms, abdominal, flank, or back pain are typical. Less commonly, they may experience pelvic, groin, or thigh pain.
hypotension
Patients with ruptured aneurysm may present with cardiovascular collapse.[42] The classic triad of hypotension, abdominal and/or back pain, and a pulsatile abdominal mass is present in about 50% of patients with a ruptured AAA.[3]
However, patients with intact AAA are usually asymptomatic and their aneurysm is detected incidentally or through screening.[3][4]
loss of consciousness
Patients with ruptured AAA may present with loss of consciousness.[42]
abdominal distension
May be present in ruptured AAA.[3]
fever
May be present in infectious AAA.[3]
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