DX: 1. Abdominal aorta aneurysm with mural thrombus. 2. Acute calculous cholecystitis

The clinical history makes an important contribution to our diagnostic impressions often even without haven't seen the image itself. An elderly women with diffuse abdominal pain is ambigous and the first approach is almost always an ultrasound. The clinical indication could be biliary colic? pancreatitis?

The ultrasound gave us 2 cytic images in appereance that could often be mistaken as cysts or even maybe dilated bowel loops with liquid intraluminal content? (wild guess). We are trying to seek cause of abdominal pain and there are 2 cystic images. Doppler ultrasound confirms that one is the aorta wich is dilated, and the other is the Gallbladder  that seems hydropic with engorged walls and intraluminal gallstones.

The reason for angiotomography was? confirm diagnosis? seek complications?. Is the ultrasound enough for treatment options and prognosis?..bottom line, wich one of the findings is the ACTUAL CAUSE OF PAIN?

Angiotomography confirmed both diagnosis and revealed the extension of mural thrombus and that is not blocking ositum of arterial ramification pathways. Also there is no leaking or any sign of disection or rupture. These latter are the most important clues to exclude other causes of life-threating abdominal pain and is a must   to recommend AngioCT when encountering abdominal aneurysm.

We know that an aneurysm is ussually defined as an outer aortic diameter over 3 cms (normal 2cms). If the diameter exceeds 5.5 cms is consider to be large and has a 25% probability of rupture. If it's not surgicaly treated it has a 17% of survival in 5 years. This, in terms of prognosis.

If an aneurysm is found  incidentally without clinical compliants and is less than 5.5cms, she is qualified for ultrasound screening. This is a grade B recommendation promoted by the US Preventive Services Task Force. The mainstay of this conservative treatment is smokin cessation.


All comments are welcome!



Lederle FA, Wilson SE, Johnson GR, et al. (May 2002). "Immediate repair compared with surveillance of small abdominal aortic aneurysms". N Engl J Med 346 (19): 1437–44