What's the diagnosis? By Dr. Angela Ugorets
An 81 yo female presents to the ED with abdominal pain for 3 days. While in the ED she suddenly became unresponsive. You put an ultrasound on her abdomen and immediately call surgery. She has a CT which confirms your suspicion. What's the diagnosis? Scroll down for answer.
Answer: Abdominal Aortic Aneurism (AAA) Rupture
- More common in the elderly, smokers, caucasians, men, patients with a history of HTN, connective tissue disease
- Consider in any patient with abdominal pain and hypotension
- Do not rely on palpating pulsatile abdoinal mass (sensitivity ranges 22-96%) and the exam may be difficult in the obese
- Abdominal ultrasound is 95% sensitive and 100% specific for AAA
- Resuscitation measures with large bore IV access, blood transfusion (usually massive transfusion protocol), allow permissive hypotension (SBP ~ 70-80) to limit hemorrhage, protect airway
- Stat vascular surgery consult for emergent repair
- An estimated 50% of ruptured AAA reach the hospital alive, 50% of those do not survivie. 100% mortality unrepaired ruptured AAA
- Rupture risk increases with increasing diameter of AAA (0% with AAA < 4cm to 30-50% with AA > 8cm)
- Indications for elective surgery: male with AAA > 5.5cm, female with AAA >5cm, rapid growth > 1cm/year
Aggarwal, Sourabh, et al. “Abdominal Aortic Aneurysm: A Comprehensive Review.” Experimental and Clinical Cardiology, vol. 16, no. 1, 2011, pp. 11–15., www.ncbi.nlm.nih.gov/pmc/articles/PMC3076160/.