Differential Diagnosis for Intermittent Pulse in Mid Abdomen

Single Most Likely Diagnosis

• Abdominal Aortic Aneurysm (AAA): This condition is characterized by a bulge in the aorta, which can cause a palpable pulse in the mid abdomen. The symptom being more noticeable in the morning could be due to increased blood pressure variability during this time.

Other Likely Diagnoses

• Aortic Stenosis: Although typically associated with symptoms like chest pain, syncope, and heart failure, significant aortic stenosis can lead to a prominent aortic pulse that might be felt in the abdomen, especially if the aneurysm or stenosis affects the abdominal aorta.
• Coarctation of the Aorta: This congenital condition involves narrowing of the aorta, which can lead to increased blood pressure above the narrowing and decreased blood pressure below. It might cause a palpable abdominal pulse due to collateral circulation.
• Pulsatile Mass: A pulsatile mass in the abdomen could be due to various causes, including aneurysms of other abdominal arteries or a highly vascular tumor.

Do Not Miss Diagnoses

• Ruptured Abdominal Aortic Aneurysm: Although this would typically present with severe abdominal pain and potentially hypotension, a contained rupture could have a more subtle presentation, including a palpable abdominal pulse.
• Aortoenteric Fistula: A communication between the aorta and the intestine, which can be a complication of an AAA or other aortic pathology, leading to gastrointestinal bleeding and potentially a palpable abdominal mass or pulse.
• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, which might be perceived as an intermittent pulse in the abdomen, especially if the tumor is large enough to be palpable.

Rare Diagnoses

• Arteriovenous Malformation (AVM): An abnormal connection between arteries and veins, which can occur in various parts of the body, including the abdomen. A large AVM could potentially cause a palpable pulse.
• Splenic Artery Aneurysm: Although rare, aneurysms of the splenic artery can occur and might cause a palpable pulse in the left upper quadrant of the abdomen.
• Renal Artery Aneurysm: Similar to splenic artery aneurysms, aneurysms of the renal arteries are rare but could potentially cause a palpable abdominal pulse, depending on their size and location.