Case 4: A 52 Year-old Woman with a 6cm AAA and Mural Thrombus

A 52 year-old woman is referred to clinic for evaluation of an incidental finding of an AAA on lumbar x-ray during work-up for back pain. _History also reveals post-prandial pain.

Past Medical History Dyslipidemia Current pack day smoker

Past Surgical History Hysterectomy Lumbar fusion L4/L5

Medications Pravastatin 40mg daily Metoprolol 25mg twice daily

Family History No aortopathies.

BP 107/68, HR 86 bpm, Wt 59 kg, BMI 20.5 kg/m² • Cardiac: RRR, no murmur  • Abdominal/GI: Thin, soft, non-tender, deep palpable pulsatile mass • Extremity: Warm, soft, no edema

• Pulse/vascular exam: 2+/2 symmetric radial, DP, PT

Labs

WBC 10.1 Cr 0.77 aPTT 31.3 sec Lactic acid 1.1

Hgb 12.2 CrCl >60 PT 11.2 sec A1c 5.5

Hct 41.6 INR 1.0

PLT 245

• Infrarenal aortic aneurysm. • It measures 6.0 x 6.0 cm. • Large mural thrombus within the

aneurysm sac. • The patent lumen measures 3.7 x

4.4 cm. • There is a small amount of mural

thrombus along the proximal SMA. • The celiac axis and IMA are

patent.

Coronal View

Transverse view SMA with intraluminal filling defect

1 2

3 4

Discussion