Question of the Week #482

A 63-year-old woman comes to the emergency department complaining of severe midabdominal pain. She reports that the pain has increased in intensity over the past few days. There has been no associated nausea or vomiting, no change in bowel habits, and no relief afforded by position changes. She is postmenopausal and does not take hormone replacement therapy. She has a 30-year history of hypertension, and has been noncompliant with her therapy of calcium channel blocker and thiazide diuretic. On examination her abdomen is obese but there is a suggestion of a nontender, pulsatile mass in the epigastric region. The remainder of the physical examination is normal. Which of the following is the best next step in management?

A. Abdominal ultrasound
B. Abdominal CT scan without contrast
C. Abdominal CT scan with contrast
D. Angiography
E. Observation

8 Responses

  1. CT abdomen with contrast

    • CT abdomen with contrast

  2. Abd. Ultrasound sounds à reasnsnle next step

  3. Abdominal ultrasound….

  4. A

  5. C. Abdominal CT scan with contrast

  6. A

  7. C pt is obese so usd is not effective to rule out AAA
    my 2 cents

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