Most people with an AAA have no symptoms. However, if an aneurysm is rapidly increasing in size or rupturing there will be symptoms. These are usually large aneurysms.
Any patient over 50 years of age who has abdominal, back or flank pain (pain in the side), especially when associated with syncope (fainting) or shock, should have an abdominal aortic aneurysm(AAA) excluded.
Progressive symptoms will be of particular concern. Any patient who has these symptoms and a known AAA should have a presumptive diagnosis of ruptured AAA.
A rapidly expanding or ruptured AAA can be difficult to diagnose. Ruptured AAAs can also be misdiagnosed as renal colic, pancreatitis, bowel ischemia, diverticulitis, cholecystitis, bowel obstruction and myocardial infarction.
The classic presentation of a ruptured AAA is the triad (group of three) of:
• severe abdominal, back or flank pain (which can radiate to the chest, groin or leg);
• shock or hypotension (due to loss of blood); and
• a pulsating abdominal mass.
Only a minority of patients with a rapidly expanding or ruptured AAA present with this classic triad.
The most consistent presenting feature is pain, followed by low blood pressure (hypotension). However, the blood pressure may be normal. A high index of suspicion is required on the part of the doctor making the diagnosis. Doctors should consider a diagnosis of an expanding or ruptured AAA in patients with any of the symptoms or signs of an AAA.