AAAs are usually asymptomatic until they expand or rupture. An expanding AAA causes sudden, severe, and constant low back, flank, abdominal, or groin pain. Syncope may be the chief complaint, however, with pain less prominent.
Most clinically significant AAAs are palpable upon routine physical examination. The presence of a pulsatile abdominal mass is virtually diagnostic but is found in fewer than half of all cases.
Patients with a ruptured AAA may present in frank shock, as evidenced by cyanosis, mottling, altered mental status, tachycardia, and hypotension. Whereas abrupt onset of pain due to rupture of an AAA may be quite dramatic, associated physical findings may be very subtle. Patients may have normal vital signs in the presence of a ruptured AAA as a consequence of retroperitoneal containment of hematoma.
At least 65% of patients with a ruptured AAA die of sudden cardiovascular collapse before arriving at a hospital.
See Presentation for more detail.
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Radiograph shows calcification of abdominal aorta. Left wall is clearly depicted and appears aneurysmal; however, right wall overlies spine.
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On radiography, lateral view clearly shows calcification of both walls of abdominal aortic aneurysm, allowing diagnosis to be made with certainty.
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CT demonstrates abdominal aortic aneurysm (AAA). Aneurysm was noted during workup for back pain, and CT was ordered after AAA was identified on radiography. No evidence of rupture is seen.
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Arteriography demonstrates infrarenal abdominal aortic aneurysm. This arteriogram was obtained in preparation for endovascular repair of aneurysm.
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Lateral arteriogram demonstrates infrarenal abdominal aortic aneurysm. Demonstration of superior mesenteric artery, inferior mesenteric artery, and celiac artery on lateral arteriogram is important for complete evaluation of extent of aneurysm.
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Arteriogram after successful endovascular repair of abdominal aortic aneurysm.
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Ultrasonogram from patient with abdominal aortic aneurysm (AAA). This aneurysm was best visualized on transverse or axial image. Patient underwent conventional AAA repair.
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MRI of 77-year-old man with leg pain believed to be secondary to degenerative disk disease. During evaluation, abdominal aortic aneurysm was discovered.
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Age is risk factor for development of aneurysm.
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Inflammation, thinning of media, and marked loss of elastin.
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Pulsatile abdominal mass.
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Aneurysm with retroperitoneal fibrosis and adhesion of duodenum.
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Aortic endoprosthesis (Cook aortic and aortobi-iliac endograft).
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Endoaneurysmorrhaphy
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Endovascular grafts.
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Atheroemboli from small abdominal aortic aneurysms produce livedo reticularis of feet (ie, blue toe syndrome).
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Enhanced spiral CT scans with multiplanar reconstruction and CT angiogram.
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Angiography is used to diagnose renal area. In this instance, endoleak represented continued pressurization of sac.
