What's the Diagnosis? By Dr. Eric Chavis
A 79 yo M w/ past medical history of HTN and DM presents with a 3 day history of lower back pain. He reports a sycnopal event the morning of his ED visit. He denies chest pain, abdominal pain or palpitations. Initial BP is 130/90 with a HR of 89. Exam is significant for periumbilical tenderness and bilateral lower lumbar paraspinal tenderness. A CT is shown below. What's the diagnosis? (scroll down for answer)
Answer: Ruptured Abdominal Aortic Aneursym with retroperitoneal hemorrhage
- CT scan shows 6.1 cm ruptured AAA with retroperitoneal hemorrhage
- Initial management - ABCs and stat vascular surgery consult - pt needs OR!
- Type and cross for blood
- BP controls for MAP 70-80
- Abdominal Aortic Aneurysm
- Defined by aorta > to 3cm
- Classic triad (1/3 of patients)- abdominal/flank pain, pulsatile abdominal mass, and hypotension
- Most commonly: male sex, age > 60, hx of HTN or hx of connective tissue disease
Tintinalli, J. E., Stapczynski, J. S., Ma, O. J., Cline, D., Meckler, G. D., & Yealy, D. M.(2016).Chapter60:Aneurysmal Disease. In Tintinalli's emergency medicine: A comprehensivestudy guide. New York: McGraw-Hill.