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• W2008884659 abstract "To the Editor: A 75-year-old man with epigastric pain and near syncope was sent to the emergency department (ED). He had a medical history of hypertension and cardiac bypass surgery. His pulse was 80 beats per minute, and blood pressure was 98/66 mmHg. On physical examination, the physician found him to be acutely ill-looking and to have mild tenderness in his epigastric area. Blood tests showed hemoglobin of 10.7 g/dL, a platelet count of 11,600/mL, and a creatinine level of 1.9 mg/dL. Abdominal radiograph showed a large calcified mass in the mid-abdomen (Figure 1A). Emergent abdominal computed tomography (CT) showed fusiform dilatation of the abdominal aorta and contrast medium extravasation in the mid-abdomen (Figure 1B). The man received emergent operation but died during the procedure. Abdominal aortic aneurysm (AAA) is a life-threatening disease that affects 5% to 9% of the population aged 65 and older.1 It is four to five times as common in men as in women. Such aneurysms are rare in women younger than 55.2 Mortality with a ruptured AAA is 41% to 50% and is directly associated with timeliness of diagnosis and surgical intervention; misleading and atypical presentation caused most delays.3 Ruptured AAAs have a wide variety of presenting symptoms.4-6 The classical presentation of a ruptured AAA includes the triad of hypotension, abdominal or back pain, and a pulsatile abdominal mass, although this triad is present in only 25% to 50% of individuals.7 The diagnosis requires a high index of suspicion in all individuals with risk factors, including male sex; older age; and a history of hypertension, smoking, or dyslipidemia.8 Smoking is the risk factor most strongly associated with AAA, with the excess prevalence associated with smoking accounting for 75% of all aneurysms 4.0 cm or more in diameter.2 Bedside ultrasound and CT have been shown to be accurate in diagnosing AAA. Plain radiographs have limited usefulness in the diagnosis of ruptured AAA, with characteristic findings of calcified aneurysm, loss of psoas or renal outline, or renal displacement.9 In a retrospective analysis from Australia, overall mortality from a ruptured abdominal aorta is 32.3%. Chronic obstructive pulmonary disease and old age are risk factors for mortality.10 The present case highlights the importance of considering the diagnosis of abdominal aortic aneurysm when indicated by abdominal radiograph. For epigastric pain, elderly adults should pay more attention to cardiovascular, gallbladder, and biliary disease than peptic ulcer diseases or gastritis commonly seen in the young population.11 Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Concept and design: Ho, Cheung. Acquisition of subjects and data: Chou, Cheung, Ho. Analysis and interpretation of data: Cheung, Ho. Preparation of manuscript: Ho, Cheung. Critical review and approval: all authors. Sponsor's Role: None." @default.
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• W2008884659 date "2013-12-01" @default.
• W2008884659 modified "2023-10-10" @default.
• W2008884659 title "Ruptured Abdominal Aortic Aneurysm in an Elderly Man" @default.
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• W2008884659 doi "https://doi.org/10.1111/jgs.12569" @default.
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