++

Key Features

++

Essentials of Diagnosis

+

  • • Most aortic aneurysms are asymptomatic until rupture, which is catastrophic

    • Aneurysms measuring 5 cm are palpable in 80% of patients

    • Back or abdominal pain with aneurysmal tenderness may precede rupture

    • Hypotension

    • Excruciating abdominal pain that radiates to the back

++

General Considerations

+

  • • The aorta of a healthy young man measures approximately 2 cm

    • An aneurysm is considered present when the aortic diameter exceeds 3 cm

    • Aneurysms rarely cause rupture until diameter exceeds 5 cm

    • 90% of abdominal atherosclerotic aneurysms originate below the renal arteries

    • Aortic bifurcation is usually involved

    • Common iliac arteries are often involved

++

Demographics

+

  • • Found in 2% of men over age 55

    • Male to female ratio is 4:1

++

Clinical Findings

++

Symptoms and Signs

+

  • • Most asymptomatic aneurysms are discovered as incidental findings on ultrasound or CT imaging

    • Symptomatic aneurysms

    • – Mild to severe midabdominal pain due to aneurysmal expansion often radiates to lower back

      – Pain may be constant or intermittent, exacerbated by even gentle pressure on aneurysm sack, and may also accompany inflammatory aneurysms

    • Inflammatory aneurysms have an inflammatory peel, similar to the inflammation seen with retroperitoneal fibrosis, surrounds the aneurysm and encases adjacent retroperitoneal structures, such as the duodenum and, occasionally, the ureters

    • Ruptured aneurysms

    • – Severe pain

      – Palpable abdominal mass

      – Hypotension

      – Free rupture into the peritoneal cavity is lethal

      – Most aneurysms have a thick layer of thrombus lining the aneursymal sac;

      – Embolization to lower extremities is rarely seen

++

Differential Diagnosis

++
++

Diagnosis

++

Laboratory Tests

+

  • • Even with a contained rupture, there may be little change in routine laboratory findings

    • Hematocrit will be normal, since there has been no opportunity for hemodilution

    • Patients with aneurysms may also have the cardiopulmonary diseases of elderly male smokers, which include

    • – Coronary artery disease

      – Carotid disease

      – Renal impairment

      – Emphysema

    • Preoperative testing may indicate the presence of these comorbid conditions

++

Imaging Studies

+

  • • Abdominal ultrasonography

    • – Diagnostic study of choice for initial screening

      – Useful in screening 65- to 74-year-old men, but not women, who have a history of smoking

      – Repeated screening does not appear to be needed

    • Abdominal or back radiographs: curvilinear calcifications outlining portions of aneurysm wall may be seen in approximately 75% of patients

    • CT scans

    • – Provide a more reliable assessment of aneurysm diameter

      – Should be done when the aneurysm nears the diameter threshold (5.5 cm) for treatment

    • Contrast-enhanced CT scans

    • – Show the arteries above and below the aneurysm

      – Visualization of this vasculature is essential for planning repair ...

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