Pulsatile Abdominal Mass

Abstract

When a pulsatile abdominal mass is found, the patient’s medical and surgical histories, the location of the mass, and the associated symptoms are essential clues to formulating a diagnostic and treatment plan. The underlying condition may range in severity from benign to life threatening. Further evaluation is imperative because, depending on the source of the pulsatile mass, immediate transport to the operating room or endovascular suite may be necessary. Here, the evaluation and management of patients presenting with pulsatile abdominal masses in both the emergent and elective settings are discussed. The careful selection of patients appropriate for repair, an evidence-based approach to imaging and risk stratification, and new techniques in resuscitation of and endovascular or hybrid approaches to patients with ruptured aneurysms are emphasized. Figures show a diagnostic and treatment algorithm for the patient presenting with a pulsatile abdominal mass, computed tomography (CT) image of a pulsatile abdominal mass distorting the anterior abdominal wall, CT image of an isolated right iliac artery aneurysm, CT image of a previous endovascular repair with kinking of the left iliac limb, aortic color flow duplex ultrasound image of a ruptured abdominal aortic aneurysm following aneurysm repair, a CT image of a ruptured aortic aneurysm, and an aortic occlusion balloon used to obtain proximal control in a ruptured infrarenal abdominal aneurysm. The video shows pulsations in the abdominal wall in a patient with a large aneurysm. Tables list classification of endoleaks, anatomic considerations for endovascular repair of aortic aneurysms using Food and Drug Administration-approved endografts, recommended surveillance intervals by aneurysm size, comparison of factors used to estimate risk in the Revised Cardiac Risk Index and the American College of Surgeons National Surgical Quality Improvement Project Myocardial Infarction or Cardiac Arrest, and risk factors for the prediction of long-term mortality following elective abdominal aortic aneurysm repair. This review contains 7 highly rendered figures, 1 video, 5 tables, and 92 references