Images in Clinical Medicine

Abdominal Aortic Aneurysm as an Incidental Finding

Peter H. Lin, M.D., and Alan B. Lumsden, M.D.

N Engl J Med 2003; 348:1884May 8, 2003

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Article

A 56-year-old man was involved in a minor bicycle accident in which the handlebars of the bicycle struck his abdomen. He came to the emergency room with swelling and pain in his anterior abdomen. He had a history of atrial fibrillation, which required oral anticoagulant therapy. Physical examination revealed fullness and mild tenderness in his right periumbilical region, with a large pulsatile abdominal mass. A computed tomographic scan of the abdomen revealed a right-sided hematoma of the rectus sheath, 8 cm by 6 cm (small arrow), with the incidental finding of an infrarenal abdominal aortic aneurysm, 7 cm in diameter (large arrow). The patient underwent surgery to repair the abdominal aortic aneurysm and evacuate the rectus-sheath hematoma. He had an unremarkable postoperative recovery and was discharged to his home five days later.

Peter H. Lin, M.D.
Alan B. Lumsden, M.D.
Baylor College of Medicine, Houston, TX 77030