Misdiagnosis of ruptured abdominal aortic aneurysms

Abstract

Ruptured abdominal aortic aneurysm is a surgical emergency with a high mortality rate even when diagnosed and repaired immediately. We retrospectively reviewed 152 cases of ruptured abdominal aneurysms to identify the incidence of misdiagnosis leading to a delay in treatment, the most frequent misdiagnoses, and the outcome in this group of patients. Forty-six (30%) were initially misdiagnosed. The most common misdiagnoses were renal colic, diverticulitis, and gastrointestinal hemorrhage. The most common initial physical findings in misdiagnosed patients were abdominal pain (70%), shock (57%), and back pain (50%). A pulsatile abdominal mass was found in only 26% of misdiagnosed patients versus 72% of patients correctly diagnosed (p less than 0.005). Misdiagnosed ruptured abdominal aneurysm had a 44% mortality rate, which was not significantly different from patients correctly diagnosed (58%, p = 0.34). The lack of difference in mortality rates is most likely due to preselection of those misdiagnosed patients who were able to withstand the delay in diagnosis and survive to surgical treatment. The 30% incidence of misdiagnosis in this series suggests that it is frequently a difficult diagnosis to make and must be considered in elderly patients, especially men, who are admitted with abdominal pain and/or back pain.

Clinical relevance of seasonal changes in the prevalence of ureterolithiasis in the diagnosis of renal colic

“…An association between temperature and the seasonal pattern of urinary stone disease has been observed [ 22 ]. As shown in the present study, numerous studies support the idea of an increased frequency of renal colic with increasing temperature [ 8 , 21 ]. Two major theories have been proposed.…”

“…Back, flank, and lower abdominal pain are some of the most important symptoms accompanying urinary stone disease; ureterolithiasis, however, does not involve specific symptoms [ 8 – 10 ]. Therefore, radiological imaging is often necessary to definitely differentiate ureterolithiasis from other conditions with similar symptoms at initial presentation [ 11 ].…”

Ruptured abdominal aortic aneurysm diagnosed through non-contrast MRI

“…Mortality rate was not found to be significantly different in misdiagnosed patients as compared to correctly diagnosed patients (16) . Our patient was 70 years old which put her in a moderate risk category and although her serum creatinine level was normal at the time of rupture, an old report suggesting high creatinine level would probably suggest that she had abnormal renal function.…”

Evaluation and management of acute abdominal pain in the emergency department

“…If tolerated by the patient, palpation or percussion may include assessment of the liver and spleen size and a search for pulsatile or other masses and an assessment of the quality of femoral pulses. A tender pulsatile and expansile mass is the key distinguishing feature of an acute abdominal aortic aneurysm, although this and most other masses are much more accurately diagnosed with the aid of a bedside ultrasound machine, if available 31. The femoral pulses may be unequal with aortic dissection 32.…”