Pediatric Signs of Abdominal Aortic Aneurysm (AAA)
The most common presenting sign of AAA in pediatric patients is a pulsatile abdominal mass, which was present in all 6 children in a single-center case series. 1
Clinical Presentation in Children
Pediatric AAA is exceedingly rare but carries significant morbidity and mortality similar to adults. 1 The key clinical features include:
Primary Presenting Sign
- Pulsatile abdominal mass is the hallmark finding, detected on physical examination in 100% of pediatric cases 1
- This differs from adults where most AAAs are asymptomatic and discovered incidentally 2, 3
Associated Symptoms
- Acute abdominal pain - when present, indicates potential impending rupture and requires emergency evaluation 2, 1
- Back pain or flank pain - may accompany abdominal symptoms 2
- Hypotension or shock - suggests rupture or contained rupture 4
Important Clinical Context
The sensitivity of individual symptoms in adults is poor (abdominal pain 61.7%, back pain 53.6%, hypotension 30.9%, pulsatile mass 47.1%), but these data are from adult populations. 5 In the pediatric series, the pulsatile mass was universally present, suggesting children may present differently than adults. 1
Age and Demographics
- Pediatric AAA can occur at any age, with reported cases ranging from 17 months to 18 years (mean age 8 years) 1
- Male predominance exists (4:2 male to female ratio in the pediatric series) 1
- Case reports document AAA in children as young as 3 years of age 4
Underlying Etiologies to Consider
Unlike adults where atherosclerosis predominates, pediatric AAA often has identifiable causes:
- Connective tissue disorders (tuberous sclerosis, suspected connective tissue disorders) 1, 6
- Vasculitis (Takayasu's arteritis) 1
- Idiopathic - no identifiable cause in approximately 67% of pediatric cases 1
- Family history of aneurysmal disease should raise suspicion 4
Diagnostic Approach
Initial Imaging
- Color Doppler ultrasonography is the primary diagnostic tool for confirming AAA in children 1
- CT angiography (CTA) provides definitive anatomic detail for surgical planning 1
Location
- All pediatric AAAs in the reported series were infrarenal in location 1
- This mirrors the adult pattern where most AAAs are infrarenal 4, 2
Critical Clinical Pitfalls
Do not dismiss abdominal masses in children as benign without imaging confirmation. The rarity of pediatric AAA means clinicians may have little direct experience with this diagnosis, leading to potential delays. 4
Rupture can occur at any size, including small aneurysms. While rare, rupture of AAAs <5 cm has been documented even in adults, and the threshold in children is unknown. 7
Symptomatic presentation (pain) indicates impending rupture and necessitates immediate emergency department evaluation, ICU monitoring, and urgent surgical consultation within 24-48 hours. 2, 8
Management Urgency
- Any pediatric patient with a pulsatile abdominal mass requires immediate imaging to rule out AAA 1
- Symptomatic pediatric AAA requires emergency surgical evaluation due to high rupture risk 8, 1
- Surgical reconstruction with aneurysm resection and prosthetic graft placement is the definitive treatment in children 1
- Untreated symptomatic AAA has a 1-year mortality >79% with median survival of only 10.4 months 8