Clinical features

The presentation may vary from asymptomatic to cardiovascular collapse or with sudden death (1).

• asymptomatic
  • usually detected on routine clinical examination or on plain abdominal radiography(1)
• symptomatic
  • pain in the abdomen, loin or lower back
  • abdominal pain may spread to the back
  • require urgent referral for investigation and management because they may indicate impending rupture
  • patient may feel a pulsatile mass in the abdomen
  • features of limb ischemia - caused by distal embolisation
  • lower extremity oedema
    • rarely seen caused by compression of the inferior vena cava (1,2)
• ruptured AAA
  • presents with the triad of - hypotension, shooting abdominal or back pain and a pulsatile abdominal mass
• this triad may be incomplete or absent in some patients, hence misdiagnosis may occur in up to 60% of the cases (3)
• rupture of the anterolateral wall into the peritoneal cavity is usually associated with death at the scene while rupture of the posterolateral wall into the retroperitoneal space are alive most of the time when they reach the hospital (4).

Note:

• clinicians should consider atypical presentation especially in patients with new-onset, non specific back or abdominal pain who are at risk of AAA (3)

Reference:

• (1) Metcalfe D, Holt PJ, Thompson MM. The management of abdominal aortic aneurysms. BMJ. 2011;342:d1384.
• (2) National Institute for Health and Care Excellence (NICE) 2009. Endovascular stent–grafts for the treatment of abdominal aortic aneurysms
• (3) Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician. 2015;91(8):538-43.
• (4) Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005;365(9470):1577-89