A 65-year-old woman on abdominal palpation presents with a tumor in the umbilical region and above it; the tumor is 13×8 cm in size, moderately painful, nonmobile, pulsing. On auscultation systolic murmur can be observed. What is the most likely diagnosis?

Answer options

1. Tricuspid insufficiency
2. Arteriovenous aneurysm
3. Abdominal aortic aneurysm
4. Gastric tumor
5. Bicuspid insufficiency

Explanation

Dilatations of localized segments of the arterial system are called aneurysms when there is a > 50 % increase in the diameter of the vessel; below 50 % they are termed ecstatic. Abdominal aortic aneurysm (AAA) is by far the most common type of large vessel aneurysm and is found in 2 % of the population at autopsy; 95 % have associated atheromatous degeneration and 95 % occur below the renal arteries. Most remain asymptomatic until rupture occurs; the risk of rupture increases with increasing size (diameter) of the aneurysm. Asymptomatic aneurysms are found incidentally on physical examination (presence of a non-mobile, pulsing tumor in the umbilical region, on auscultation -systolic murmur), radiography or ultrasound investigation. Symptomatic aneurysms may cause minor symptoms, such as back and abdominal discomfort, before sudden, severe back and/or abdominal pain develops from expansion and rupture. Rarely, symptoms may occur because of erosion or compression of surrounding structures, e.g., archenteric fistula, ureteric obstruction. Bailey & Love’s short practice of surgery. – 27th edition. – P. 961