A 72 year old male with known abdominal aortic aneurysm (5.7 cm s/p fem-tib bypass, L AKA) presents for 3 weeks with diarrhea and mild LLQ pain. No nausea, vomiting, fever, back pain, urinary symptoms, or blood in stool. He has no localizing abdominal exam & no peritoneal signs, strong even radial pulses, and normal cardiopulmonary exam. On further chart review, patient is noted to have a 5+ cm aorta for the past 2 years, with the most recent CT scan a few weeks ago showing growth from 5.5 cm to 5.7 cm. An abdominal ultrasound is performed with the following findings.
Vitals:
T 98.7 HR 64 BP 167/80 RR 18 O2 100%
What are we concerned about for this patient and why? What is the interpretation of the abdominal ultrasound? What are the next steps for management in the ED?

This post was written by Caresse Vuong, MS4, Charles Murchison, MD and Amir Aminlari MD