From the Guidelines
The classic triad of symptoms of an abdominal aortic aneurysm (AAA) consists of abdominal pain, a pulsatile abdominal mass, and hypotension. This triad typically indicates a ruptured or rapidly expanding AAA, which is a life-threatening emergency requiring immediate medical attention. The abdominal pain is often severe, constant, and located in the mid-abdomen or lower back. The pulsatile mass represents the enlarged, pulsating aorta that can sometimes be felt through the abdominal wall during physical examination. Hypotension occurs due to blood loss from the aneurysm into the retroperitoneal space or peritoneal cavity. It's essential to note that this classic triad is present in only about 25-50% of patients with ruptured AAAs, as reported in various studies 1. Many patients with intact AAAs are asymptomatic, with the aneurysm discovered incidentally during imaging studies performed for unrelated reasons. Early recognition of this triad is crucial as ruptured AAAs have a mortality rate of approximately 80-90%, and immediate surgical intervention is necessary for survival, as highlighted in the study by 1. The high mortality and morbidity associated with AAA rupture emphasize the importance of imaging screening and surveillance, as discussed in the studies 1. In the context of real-life clinical medicine, it is crucial to prioritize the side of caution and consider the potential risks and benefits of different management strategies, as outlined in the guidelines 1. Overall, the classic triad of symptoms remains a critical component of diagnosing and managing AAAs, and its recognition is vital for improving patient outcomes.
From the Research
Symptoms of Abdominal Aortic Aneurysm
The classic triad of symptoms of abdominal aortic aneurysm includes:
- Hypotension
- Back pain
- A pulsatile abdominal mass These symptoms are present in only 50% of people with ruptured abdominal aortic aneurysms (AAA) 2.
Presentation of Ruptured Abdominal Aortic Aneurysm
Ruptured abdominal aortic aneurysm is a medical emergency presenting with:
- Hypotension
- Shooting abdominal or back pain
- A pulsatile abdominal mass It is associated with high prehospitalization mortality 3.
Diagnosis and Screening
Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography 3. The U.S. Preventive Services Task Force recommends one-time screening with ultrasonography for men 65 to 75 years of age with a history of smoking 3.
Unusual Presentations
Some patients may present with unusual symptoms, such as vague abdominal pain or a misleading abdominal mass, making diagnosis challenging 4. Low back pain is also a common symptom, accompanying abdominal aortic aneurysm in 91% of cases 5.