A Vague Pain with a Serious Secret

Fig.1 – Contrast-enhanced coronal CT angiographic image demonstrating a large, tortuous aneurysm arising from the right internal iliac artery, forming a well-defined pelvic mass measuring approximately 9.4 cm in maximal diameter, with marked displacement of adjacent pelvic structures. (Image courtesy of the author)

Fig.2 – Sagittal CT image demonstrating the large pelvic aneurysm and its close relationship to the sacrum and pelvic organs, highlighting the degree of posterior displacement and mass effect. (Image courtesy of the author)

Which comorbidity increases diagnostic complexity by creating an alternative plausible explanation for the patient’s pain?

What is the most appropriate immediate management in the ED after confirming a 9.4 cm internal iliac artery aneurysm?

If the aneurysm had presented with hypotension and new abdominal tenderness, what would be the most appropriate initial haemodynamic strategy?