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Rupture of an abdominal aortic aneurysm (AAA), a leading cause of death in the elderly, is sometimes overlooked: a leaking aneurysm can have a subtle clinical presentation, and symptoms can appear before the rupture that are not recognized as related to AAA. This study at a large VA medical center assessed the frequency and causes of these missed diagnoses.
A retrospective review identified 23 men (average age, 72) with ruptured or symptomatic unruptured AAA who initially presented to an internist. The majority had abdominal, back, or flank pain, leukocytosis, and abdominal tenderness and a pulsatile mass on physical exam. Fourteen (60 percent) were initially misdiagnosed, most commonly with urinary tract infection or obstruction, spinal dis…