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 tobacco 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 tobacco use presents to his primary care physician with a 2-day history of constant and gnawing hypogastric pain. The pain has been steadily worsening in intensity. He says the pain radiates to his lower back and both groins at times. While he cannot identify any aggravating factors (such as movement), he feels the pain improves with his knees flexed. There is a palpable pulsatile mass just left of midline below the umbilicus. He is immediately referred 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.[9] A tender, palpable pulsatile 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 history of arterial trauma, intravenous drug abuse, local or concurrent infection, bacterial endocarditis. or impaired immunity. Osteomyelitis of the thoracic or lumbar spine may develop. Anemia, leukocytosis, and positive blood cultures are common.[12] Diagnosis may be aided by complications of unruptured aneurysms, including distal embolization, acute thrombosis, or symptoms caused by ureterohydronephrosis.[3][13]
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