Abdominal aortic aneurysm - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2026-04-08T20:56:42Z

Differential Diagnosis

← Older revision		Revision as of 20:56, 8 April 2026
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Renal colic]] / [[nephrolithiasis]]
	*[[Aortic dissection]]
	*[[Diverticulitis]]
	*Musculoskeletal back pain
	*[[MI]] (inferior)

	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
	~~{{Extra-abdominal sources of abdominal pain DDX}}~~

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2026-04-08T20:54:37Z

Differential Diagnosis

← Older revision		Revision as of 20:54, 8 April 2026
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	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
			{{Extra-abdominal sources of abdominal pain DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2026-04-08T20:25:55Z

Differential Diagnosis

← Older revision		Revision as of 20:25, 8 April 2026
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	*[[Renal colic]] / [[nephrolithiasis]]		*[[Renal colic]] / [[nephrolithiasis]]
	*[[Aortic dissection]]		*[[Aortic dissection]]
	*[[Mesenteric ischemia]]
	*[[Diverticulitis]]		*[[Diverticulitis]]
	*Musculoskeletal back pain		*Musculoskeletal back pain
	*[[Pancreatitis]]
	*[[MI]] (inferior)		*[[MI]] (inferior)

Rossdonaldson1: /* Differential Diagnosis */

2026-04-08T20:25:07Z

Differential Diagnosis

← Older revision		Revision as of 20:25, 8 April 2026
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	*[[MI]] (inferior)		*[[MI]] (inferior)

	{{Abdominal ~~pain~~ DDX}}		{{Abdominal Pain DDX Diffuse}}

	==Evaluation==		==Evaluation==

Danbot: Strip excess bold text - keep only critical safety emphasis

2026-03-22T09:23:03Z

Strip excess bold text - keep only critical safety emphasis

← Older revision		Revision as of 09:23, 22 March 2026
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	==Background==		==Background==
	*Focal dilation of the abdominal aorta to ~~'''~~>50% of normal diameter~~'''~~ (typically >3 cm)		*Focal dilation of the abdominal aorta to >50% of normal diameter (typically >3 cm)
	*Most commonly ~~'''~~infrarenal~~'''~~ (95%)		*Most commonly infrarenal (95%)
	*'''Ruptured AAA is a surgical emergency''' with overall mortality of '''65-85%''' (including prehospital deaths)		*'''Ruptured AAA is a surgical emergency''' with overall mortality of '''65-85%''' (including prehospital deaths)
	*For those who reach OR, mortality is still ~~'''~~40-50%~~'''~~		*For those who reach OR, mortality is still 40-50%
	*Risk factors:		*Risk factors:
	**Age ~~'''~~> 65 years~~'''~~, male sex (6:1 ratio), smoking (strongest modifiable risk)		**Age > 65 years, male sex (6:1 ratio), smoking (strongest modifiable risk)
	**[[Hypertension]], family history, [[COPD]], peripheral vascular disease		**[[Hypertension]], family history, [[COPD]], peripheral vascular disease
	**Connective tissue disorders (Marfan, Ehlers-Danlos)		**Connective tissue disorders (Marfan, Ehlers-Danlos)
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	==Clinical Features==		==Clinical Features==
	===Classic Triad of Ruptured AAA===		===Classic Triad of Ruptured AAA===
	*~~'''~~Abdominal/back pain + hypotension + pulsatile abdominal mass~~'''~~		*Abdominal/back pain + hypotension + pulsatile abdominal mass
	*Present in ~~'''~~only ~50%~~'''~~ of cases		*Present in only ~50% of cases

	===Presentations===		===Presentations===
	*~~'''~~Intact (unruptured) AAA~~'''~~: usually asymptomatic or incidental finding		*Intact (unruptured) AAA: usually asymptomatic or incidental finding
	*~~'''~~Symptomatic unruptured~~'''~~: abdominal/back/flank pain (expanding aneurysm)		*Symptomatic unruptured: abdominal/back/flank pain (expanding aneurysm)
	*~~'''~~Ruptured AAA~~'''~~:		*Ruptured AAA:
	**~~'''~~Sudden, severe abdominal or back pain~~'''~~ (may radiate to groin, flank, or thigh)		**Sudden, severe abdominal or back pain (may radiate to groin, flank, or thigh)
	**~~'''~~Hypotension~~'''~~ / hemorrhagic [[shock]]		**Hypotension / hemorrhagic [[shock]]
	**Pulsatile abdominal mass (difficult to palpate in obese or hypotensive patients)		**Pulsatile abdominal mass (difficult to palpate in obese or hypotensive patients)
	**May present as ~~'''~~syncope~~'''~~ or [[cardiac arrest]]		**May present as syncope or [[cardiac arrest]]
	*~~'''~~Contained rupture~~'''~~: retroperitoneal hemorrhage may be temporarily tamponaded		*Contained rupture: retroperitoneal hemorrhage may be temporarily tamponaded
	**Transient hemodynamic stability — '''do not be falsely reassured'''		**Transient hemodynamic stability — '''do not be falsely reassured'''
	*~~'''~~Mimics~~'''~~ many conditions: [[renal colic]], [[diverticulitis]], [[MI]], musculoskeletal back pain		*Mimics many conditions: [[renal colic]], [[diverticulitis]], [[MI]], musculoskeletal back pain

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	===Bedside Ultrasound (First-Line in ED)===		===Bedside Ultrasound (First-Line in ED)===
	*~~'''~~POCUS is the single most important test~~'''~~ for unstable patients		*POCUS is the single most important test for unstable patients
	*'''Sensitivity ~100%''' for detecting aneurysm >3 cm<ref>Tayal VS, et al. Emergency department sonographic measurement of aortic diameter. ''J Ultrasound Med''. 2003;22(12):1291-1294. PMID 14680900</ref>		*'''Sensitivity ~100%''' for detecting aneurysm >3 cm<ref>Tayal VS, et al. Emergency department sonographic measurement of aortic diameter. ''J Ultrasound Med''. 2003;22(12):1291-1294. PMID 14680900</ref>
	*Measure outer wall to outer wall in ~~'''~~transverse~~'''~~ view		*Measure outer wall to outer wall in transverse view
	*~~'''~~Cannot reliably detect rupture~~'''~~ (free fluid may suggest it but absence does not exclude)		*Cannot reliably detect rupture (free fluid may suggest it but absence does not exclude)
	*~~'''~~US identifies the aneurysm; CT identifies the rupture~~'''~~		*US identifies the aneurysm; CT identifies the rupture

	===CT Angiography===		===CT Angiography===
	*~~'''~~Gold standard for defining anatomy~~'''~~ and surgical planning		*Gold standard for defining anatomy and surgical planning
	*Identifies rupture, contained leak, extent, relation to renal arteries		*Identifies rupture, contained leak, extent, relation to renal arteries
	*~~'''~~ONLY for hemodynamically STABLE patients~~'''~~		*ONLY for hemodynamically STABLE patients
	*Sensitivity for rupture approaches 100%		*Sensitivity for rupture approaches 100%

	===Labs===		===Labs===
	*~~'''~~Type and crossmatch~~'''~~ (at least 6 units PRBCs)		*Type and crossmatch (at least 6 units PRBCs)
	*CBC, BMP, coagulation studies, lactate		*CBC, BMP, coagulation studies, lactate
	*'''Do NOT delay resuscitation or imaging for labs'''		*'''Do NOT delay resuscitation or imaging for labs'''
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	==Management==		==Management==
	===Ruptured AAA===		===Ruptured AAA===
	*~~'''~~Activate massive transfusion protocol~~'''~~		*Activate massive transfusion protocol
	*~~'''~~Permissive hypotension~~'''~~: target SBP ~~'''~~70-90 mmHg~~'''~~		*Permissive hypotension: target SBP 70-90 mmHg
	*~~'''~~Avoid aggressive crystalloid~~'''~~ resuscitation; use blood products		*Avoid aggressive crystalloid resuscitation; use blood products
	*Emergent ~~'''~~vascular surgery consultation~~'''~~		*Emergent vascular surgery consultation
	*'''Unstable patients go directly to OR''' (do NOT delay for CT)		*'''Unstable patients go directly to OR''' (do NOT delay for CT)
	**EVAR if anatomy suitable and resources available		**EVAR if anatomy suitable and resources available
	**Open surgical repair if EVAR not feasible		**Open surgical repair if EVAR not feasible
	*~~'''~~If arrest~~'''~~: consider ~~'''~~REBOA~~'''~~ or ~~'''~~ED thoracotomy with aortic cross-clamp~~'''~~		*If arrest: consider REBOA or ED thoracotomy with aortic cross-clamp

	===Symptomatic Unruptured AAA===		===Symptomatic Unruptured AAA===
	*~~'''~~Urgent vascular surgery consultation~~'''~~		*Urgent vascular surgery consultation
	*Blood pressure control: target SBP 100-120 mmHg		*Blood pressure control: target SBP 100-120 mmHg
	*Admit for expedited repair		*Admit for expedited repair
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	*4-5.4 cm: surveillance US every 6 months; vascular referral		*4-5.4 cm: surveillance US every 6 months; vascular referral
	*>=5.5 cm: refer for elective repair		*>=5.5 cm: refer for elective repair
	*~~'''~~USPSTF: one-time screening US~~'''~~ for men 65-75 who have ever smoked		*USPSTF: one-time screening US for men 65-75 who have ever smoked

	==Disposition==		==Disposition==
	*~~'''~~Ruptured~~'''~~: emergent OR / ICU		*Ruptured: emergent OR / ICU
	*~~'''~~Symptomatic unruptured~~'''~~: monitored bed, urgent vascular consult		*Symptomatic unruptured: monitored bed, urgent vascular consult
	*~~'''~~Asymptomatic incidental~~'''~~: outpatient vascular referral		*Asymptomatic incidental: outpatient vascular referral

	==See Also==		==See Also==

Danbot: Major update: POCUS sensitivity, permissive hypotension, REBOA, size-based rupture risk, USPSTF screening, surveillance guidelines, references with PMIDs

2026-03-21T19:45:26Z

Major update: POCUS sensitivity, permissive hypotension, REBOA, size-based rupture risk, USPSTF screening, surveillance guidelines, references with PMIDs

Show changes

Danbot: Add MedicationDose entries (labetalol, esmolol, nitroprusside) with SMW annotations

2026-03-20T18:43:12Z

Add MedicationDose entries (labetalol, esmolol, nitroprusside) with SMW annotations

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 *Graft infection
 *Endoleak
 ==Disposition==

Masoodrm: /* Background */

2024-06-13T20:23:21Z

Background

← Older revision		Revision as of 20:23, 13 June 2024
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	[[File:AneurysmAortaWithArrows.jpg\|thumb\|CT reconstruction image of an abdominal aortic aneurysm (white arrows).]]		[[File:AneurysmAortaWithArrows.jpg\|thumb\|CT reconstruction image of an abdominal aortic aneurysm (white arrows).]]
	*Different types		*Different types
	**Fusiform- Bulging or ballooning of all sides of the aorta~~; more common~~		**Fusiform (~92%)- Bulging or ballooning of all sides of the aorta
	**Saccular- Bulging or ballooning of only one side of the aorta		**Saccular (~5%)- Bulging or ballooning of only one side of the aorta
	**Mycotic- Caused by an infection of the vessel wall		**Mycotic (less than 3%)- Caused by an infection of the vessel wall
			***More common in Asian countries, can be as much as 13%
	***May be bacterial, viral, or fungal		***May be bacterial, viral, or fungal
	***May be a complication of infectious endocarditis		***May be a complication of infectious endocarditis
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	*Infrarenal diameter >3cm or >50% increase in size of diameter		*Infrarenal diameter >3cm or >50% increase in size of diameter
	**85% of cases are infrarenal <ref name="NJM"></ref>		**85% of cases are infrarenal <ref name="NJM"></ref>
			**Mean growth rate is about 0.2-0.3 cm/yr
	*Rupture Risk		*Rupture Risk
	**<4cm: low risk for rupture		**<4cm: low risk for rupture

Masoodrm: /* Background */

2022-09-13T17:00:32Z

Background

← Older revision		Revision as of 17:00, 13 September 2022
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	[[File:Aorta branches.jpg\|thumb\|Branches of the aorta.]]		[[File:Aorta branches.jpg\|thumb\|Branches of the aorta.]]
	[[File:AneurysmAortaWithArrows.jpg\|thumb\|CT reconstruction image of an abdominal aortic aneurysm (white arrows).]]		[[File:AneurysmAortaWithArrows.jpg\|thumb\|CT reconstruction image of an abdominal aortic aneurysm (white arrows).]]
	*2 Different types		*Different types
	**Fusiform- Bulging or ballooning of all sides of the aorta; more common		**Fusiform- Bulging or ballooning of all sides of the aorta; more common
	**Saccular- Bulging or ballooning of only one side of the aorta		**Saccular- Bulging or ballooning of only one side of the aorta
			**Mycotic- Caused by an infection of the vessel wall
			***May be bacterial, viral, or fungal
			***May be a complication of infectious endocarditis
			***Increased risk of rupture
	*Infrarenal diameter >3cm or >50% increase in size of diameter		*Infrarenal diameter >3cm or >50% increase in size of diameter
	**85% of cases are infrarenal <ref name="NJM"></ref>		**85% of cases are infrarenal <ref name="NJM"></ref>
	*M to F ratio is 4:1
	*Rupture Risk		*Rupture Risk
	**<4cm: low risk for rupture		**<4cm: low risk for rupture
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	===Risk Factors===		===Risk Factors===
			*Gender (male to female ratio 4:1)
	*Smoking		*Smoking
	**Risk factor most strongly associated with AAA		**Risk factor most strongly associated with AAA

Blsimpso: /* Disposition */

2021-07-08T14:39:21Z

Disposition

← Older revision		Revision as of 14:39, 8 July 2021
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	==Disposition==		==Disposition==
	*Admit to OR ~~in cases of~~ ruptured OR		*Admit to OR for ruptured or symptomatic AAA
	*~~Vasc~~ surgery follow up ~~in asymptomatic cases~~		*May discharge asymptomatic cases with close vascular surgery follow up
			**Instruct to return immediately if symptoms manifest (abdominal/back pain, syncope, dizziness, extremity pain)

	==External Links==		==External Links==