Friday, April 23, 2010

What is the most likely diagnosis of this case?

A 90 years old man with a history of Coronary artery disease, Hypertension, and a 30-pack year smoking history presents to the outpatient clinic for his annual checkup.

He denies recent complaints ,although reports that he has not been as "active" lately.He has a history of good adherence to health maintenance recommendations,and results of recent colonoscopy and prostate axamination are negative.
He takes aspirine,metoprolol,and an occasional multivitamins.He admits to having problems with smoking cessation.

Vital signs:
Temprature : 37.0°C (98.6°F)
Blood pressure:120/80 mm Hg
Pulse rate:60/min
Respiratory rate:10/min
Physical exam.shows a thin, elderly man withmotteled skin.His Heent , neck,chest and cardiac examination is unremarkable.
His abdomin is not tender and nondistended, but apulsating mass is palpated approximately 2 cm superior to his umbilicus, 1 cm left of midline.

The correct answer: in 25 April 01
Abdominal Aortic Aneurysm
Approximitaely 30% of AAAs are discovered during routine physical examination,although they are more difficult to detect in obese patients or when the aneurysm is small.
It occurs almost exclusively in people >60 years old(4-6%>60 have an AAA).it is associated with atherosclerosis,smoking,hypertension and a family history of AAAs.