An 84 yo female presents with days of progressive right sided abdominal pain / right flank pain.  Vital signs are normal. A cat scan is shown below.  What's the diagnosis?  Scroll down for answer.

Answer:  Abdominal Aortic Aneurysm (AAA)

• CT shows an 8cm infrarenal aortic aneurysm without rupture
• In this patient with ncreasing abdominal pain and large aneurysm the next appropriate step is ED vascular surgery consultation for OR
• Most AAA are asymptomatic until they leak or rupture
• Some patients may have mild progressive low back pain, abdominal pain, or groin pain with aneurysm expansion
• Patients may present with comlications of AAA such as aortocaval fisutal, aortoenteric fistula (GI bleed), thrombosis, compression of adjacent structures
• Mortality rate of rupture is high (69-83%)
• Risk of rupture is related to size of aneurysm, surgical intevention generally recommended in aneurysms >5cm in women and >5.5cm in men

Tintinalli JE, Stapczynski JS, Ma OJ, YealyDM, Meckler GD, Cline. Chapter 60. (2016) Tintinalli’s Emergency Medicine: A Comprehensiv Study Guide, 8e. McGraw Hill.  

Radiopedia:https://radiopaedia.org/articles/abdominal-aortic-aneurysm