3222 A Rare Presentation of a Sizable Asymptomatic Abdominal Aortic Aneurysm

Abstract

INTRODUCTION: An abdominal aortic aneurysm (AAA) occurs as plaque builds up in vessels due to long-standing atherosclerosis. AAA takes years to develop and has few if any noticeable symptoms during this time. The larger an aneurysm becomes, the more likely symptoms develop including abdominal pain, back pin, dizziness and nausea. Significant risk factors for the development of AAA include smoking, hypertension, old age and family history. Aneurysms are more likely to burst and rupture as its size increases. Symptoms generally develop when an AAA becomes larger than 3 cm and elective repair should be considered for aneurysms measuring greater than 5.5 cm in size. Here, we present a case of an asymptomatic patient presenting to the hospital with an incidental AAA measuring 14 × 11 cm. CASE DESCRIPTION/METHODS: A 100-year-old female with a history of dementia, emphysema secondary to 25 pack year smoking, and anemia presented to the hospital with right leg pain after a recent mechanical fall. She denied any complaints at the time of admission including chest pain, shortness of breath, dizziness, nausea, abdominal pain and back pain. CT of the pelvis revealed acute right subcapital femoral neck fracture as well as a large infrarenal AAA measuring 14 × 11 cm with high risk for rupture. Cardiology was consulted for preoperative risk assessment for hemiarthroplasty versus percutaneous pinning of the right femoral neck. Patient was deemed too high of a risk for hemiarthroplasty and decision was made by medical team to pursue percutaneous pinning although patient remained high risk for surgery due to large AAA. While patient was in the operative room immediately prior to surgery, the patient developed hypotension and hypoxia. After discussion with family and medical team, patient opted for palliative care. DISCUSSION: The case highlights an extreme clinical presentation of a massive AAA that was found incidentally on imaging after a recent mechanical fall. Current guidelines recommend that an AAA should be surgically evaluation when its size exceeds 5.5 cm due to the life threatening risk of rupture. This patient's unusual presentation of a large AAA despite not presenting with any of the classical symptoms is concerning because of the risk associated with spontaneous rupture and death. More research is needed for the evaluation and screening of AAA's to prevent potential catastrophic complications.