Aorta… Aneurysm and beyond!

Author: Lokeshwar Singh / Editor: Sarah Edwards / Codes: / Published: 10/11/2022

A 65-year-old man presents to the Emergency Department (ED) with pain over the left side testicle as well as over his bladder. He has had the pain for over 2 months. He does not report any other gastrointestinal or genitourinary issues.

Past medical history: Type 2 Diabetes Mellitus, hypertension, epilepsy

Drug history: Omeprazole, levetiracetam, metformin, Alogliptin, Atorvastatin.

Drug/Alcohol history: He smokes occasionally. Drinks socially.

Social history: He is retired.

The patient was seen in ED, 1 week ago with similar issues and was advised analgesia as observations were stable, blood results were unremarkable and urine dip was clear.

He says that the pain medications have made no difference to his situation. He denies any fall, injury to the back or urinary /faecal incontinence, as well as fever, chills or rigors. He was advised to follow up with his GP who also had reviewed prescribed antibiotics (Epidydymitis) and booked ultrasound scan of testes which was due in 3 weeks.

As his symptoms were not any better, he has presented to the ED today again.

Bloods, observations, and urine dip are still normal. You decide to do an ultrasound of the abdomen as something does not quite sound right. US shows a 5.6 cm aneurysm in abdominal aorta.

The patient is moved to Resus, large bore IV access obtained, blood samples for group and save sent and an emergency CT Angiogram aorta is done.

The CT report is as follows: Infrarenal abdominal aortic aneurysm confirmed which extends down to just before the bifurcation. Atheromatous plaque seen posteriorly with intimal rim calcification. No acute aortic leakage seen but there is periaortic thickening (13mm) and haziness of the left side suggesting aortitis.

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