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Potentially life-threatening emergency
Abdominal aortic aneurysm
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Other Resources UpToDate PubMed
Potentially life-threatening emergency

Abdominal aortic aneurysm

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Contributors: Sanuja Bose BS, BA, Benjamin L. Mazer MD, MBA, Christine Osborne MD, Abhijeet Waghray MD
Other Resources UpToDate PubMed

Synopsis

An abdominal aortic aneurysm (AAA) is defined as a focal dilation of the abdominal aorta that is ≥ 50% of the regular diameter or ≥ 3 cm. The abdominal aorta lies between the diaphragm and aortic bifurcation, with 85% of aneurysms arising infrarenally and about 15% being juxtarenal. They are most commonly degenerative in patients with atherosclerosis, but 5%-10% may be inflammatory and are more often symptomatic.

AAAs are most commonly diagnosed in men with a smoking history, but other risk factors for development are advanced age, previous aneurysm, atherosclerotic disease, hypertension, a family history of AAA, and Northern European descent.

Aneurysms expand with time but typically remain asymptomatic until rupture. Thus, patients require serial abdominal ultrasounds following diagnosis to assess the rate of growth and risk of rupture, with rupture risk directly correlating with the size of the aneurysm. In the rare patients who complain of symptoms prior to rupture, these most commonly include abdominal, back, or flank pain. Other signs and symptoms may include hematuria, gastrointestinal hemorrhage, or lower extremity ischemia. A pulsatile periumbilical abdominal mass may be found on physical examination with a bruit heard on auscultation.

Identifying an AAA is essential as mortality associated with rupture is 85%-90% and still as high as 50%-70% in patients who make it to the hospital after a rupture.

Related topic: Cystic medial necrosis

Codes

ICD10CM:
I71.4 – Abdominal aortic aneurysm, without rupture

SNOMEDCT:
233985008 – Abdominal aortic aneurysm

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differential for back, abdominal, or flank pain that may be associated with a symptomatic AAA:
Differential for a pulsatile abdominal mass may include:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 12/06/2019
Last Updated: 01/29/2020
Copyright © 2020 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Abdominal aortic aneurysm
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View all Images (6)
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Abdominal aortic aneurysm : Flank pain, Abdominal mass, Cigarette smoking, Epigastric pain, Groin pain, Low back pain
Imaging Studies image of Abdominal aortic aneurysm
Axial CT image demonstrates an abdominal aortic aneurysm with mural thrombus.
Copyright © 2020 VisualDx®. All rights reserved.