Images in Clinical Medicine
Abdominal Aortic Aneurysm
N Engl J Med 2009; 360:2004May 7, 2009
- Article
A 76-year-old man presented with mild back pain of 2 weeks' duration. The physical examination revealed a blood pressure of 140/85 mm Hg and a pulsatile, nontender abdominal mass (Panel A). On cardiac examination, the point of maximal impulse was nondisplaced, and all peripheral pulses were palpable. The patient's medical history was notable for hypertension, which had been diagnosed 20 years earlier and was well controlled with medical therapy. He had undergone a laparotomy 15 years earlier for peptic ulcer disease. The patient was a nonsmoker and had no family history of aneurysm or connective tissue disease. He had received the diagnosis of abdominal aortic aneurysm 3 years earlier but had declined surgical intervention at that time. Thoracoabdominal computed tomography with intravenous administration of contrast material revealed a large infrarenal abdominal aortic aneurysm measuring 14 cm by 17 cm (Panel B, arrow) and an aneurysm in the left common iliac artery measuring 6 cm by 5 cm (arrowhead). The patient underwent a successful open repair with placement of a graft. During surgery, there was no evidence of rupture or superimposed infection. Pathological examination showed a true degenerative aneurysm in which all three layers (intima, media, and adventitia) of the arterial wall were seen, with a hyperplastic intimal layer and fragmentation of elastin fibers in the media. The postoperative course was unremarkable, and the patient was discharged home in good condition. At follow-up 12 months later, he had returned to his normal activities.
Mohammed Al-Omran, M.D.
Badr Aljabri, M.D.
King Saud University, Riyadh 11472, Saudi Arabia
malomran@ksu.edu. sa
