Abdominal Aortic Aneurysm (AAA)

Patient Presentation:
M.B., a 64 y/o male presents to the ED with sudden onset of chest and back pain described as “gnawing” and “tearing”. He says his pain is severe and constant. His PMH includes: HTN, hypercholesterolemia, and history of smoking. ROS is positive for chest pain, back pain, abdominal pain, and nausea. Pt denies SOB, cough, bloating, or F/C/N/V/D. Pt also denies alcohol and illicit drug use. VS: T 97.9, BP 90/70, HR 140, RR 24, SpO2 98% RA

Review of Systems:
Neuro: A/O x3
Lungs: CTAB. No wheezes or crackles.
Heart: S1, S2, Tachycardic but with Regular Rhythm. No murmur, rubs, or clicks.
Abd: Rigid, tender, non-distended. Pulsating sensation palpated in mid-epigastric region. BS (bowel sounds) present.
Ext: Radial pulses 2+; pedal pulses diminished at 1+.

Differential List:
MI, AAA

Diagnosis:
Both Contrast CT and Abdominal U/S would be appropriate in this situation. The Abdominal U/S was performed for a more rapid diagnosis and confirmed an AAA.

Treatment:
M.B. admitted to Vascular Surgery and underwent open repair as the aneurysm was greater than 5 cm.

Outcome:
M.B.’s open AAA repair was successful. Pt’s follow-up will include serial imaging at 3, 6, 9, and 12 months, and then annually. Pt will also be screened for other aneurysms per Vascular.

Summary:

AAAs are medical emergencies.
Risk factors include: smoking, HTN, hyperlipidemia, age (>60), and FHx (family history).
This affects men about 5-10x more than women.
Complications include: Rupture, Dissection, Thromboembolic ischemic events, and Compression of adjacent structures.
Ruptured AAA has 90% mortality.
Besides surgery, treatment can include risk factor modification (i.e. smoking cessation) and BP control (with beta-blockers, ACEi, or ARBs).

Case created by Mimi Balaji, 2011.