1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Anonymous Resident Affiliation: National Capital Consortium

2. MedPix No: 2846 - History Pt Demographics: Age = 58 y.o. Gender = man This patient was found to have a palpable mass in the abdomen in 1993 during his workup for an inguinal hernia. The patient has been asyptomatic and has been followed for his AAA. Recently, the AAA had enlarged with CT scan demonstrating an approximately 4.5-5cm infrarenal AAA. The patient aslo reported claudication at 50 to 100 yards. He is able to walk the lawnmower for 15 to 20 minutes.PMH: AAA, CAD, HTN, Hypercholesterol, BPHPSH: CABGx3, Hernia repairMED: Sertraline, Pravastatin, Aspirin, HytrinAllergy: NiacinSocial:Tobacco use of more than 2PPD for 38 yearsOccasional drinker Downloaded by (-1)

3. MedPix No: 2846 - EXAM & LABS Physical exam: abdominal mass dopplerable distal pulses ABI Left: 92/164 Right: 140/164, no clubbing, cyanosis or edema of extremities.LAB: Chem7, CBC, ABG, UA?WNL.EKG: NSR. No change from prior EKG.

4. Abdominal Aortic Aneurysm 5x5cm infrarenal abdominal aneurysm with calcified stem. No evidence of thrombus formation. Downloaded by (-1)

5. Abdominal Aortic Aneurysm 5x5cm infrarenal abdominal aneurysm with calcified stem. No evidence of thrombus formation. Downloaded by (-1)

6. Abdominal Aortic Aneurysm Infrarenal AAA. No evidence of supra-inguinal flow limiting stenosis Downloaded by (-1)

7. FINDINGS CXR: No evidence of acute cardiopulmonary diseases. Tortuous Aorta. Intact Sternotomy wires and surgical clips consistent with previous median sternotomy. Degenerative changes of thoracic spine.CT: 5x5cm infrarenal abdominal aneurysm with calcified stem. No evidence of thrombus formation.Arteriogram: Infrarenal AAA. No evidence of supra?inguinal flow limiting stenosis. artery occlusion.

8. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis?

9. Diagnosis: AAA Dx Confirmed by:

10. DISCUSSION