Massive Abdominal Aortic Aneurysm Masquerading as Heart Failure

Abstract

The United States Preventative Task Force recommends screening for all men greater than the age of 65 who have smoked more than 100 cigarettes in their lifetime or have a family history of abdominal aortic aneurysm (AAA). This is largely due to the asymptomatic nature of the presentation of most patients who present with AAA. Symptomatic AAA carries a poor prognosis if not detected in a timely manner. Although abdominal pain remains the most common symptomatic presentation, AAA is notorious to surprise clinicians by its unique masquerading ability. We here present an example of one of these unique presentations. Our case reports a 60-year-old African American male who presented with 4+ pitting edema and shortness of breath. After initial clinical assessment, new onset heart failure seemed to be the likely diagnosis. However, the grossly normal nature of echocardiogram forced us to entertain other potential possibilities. A thorough review of the human anatomy and critical multispecialty decision making paved way for intra-abdominal imaging which revealed a massive AAA extending to the common iliac arteries compressing the inferior vena cava. We discuss the existing literature and try to find reasons why diagnosing AAA is still not a perfected art.




J Med Cases. 2016;7(8):361-363
doi: http://dx.doi.org/10.14740/jmc2582w