A 68-year-old man with a pulsatile abdominal bulge measures 7 cm above the umbilicus. What is the best initial diagnostic test?

A 68-year-old man with a pulsatile abdominal bulge measures 7 cm above the umbilicus. What is the best initial diagnostic test?

• A. Ultrasound of abdomen
• B. MRI abdomen
• C. CT scan with contrast of the abdomen and pelvis
• D. Angiography

Answer: (C)

A pulsatile abdominal mass in an older man points to an abdominal aortic aneurysm, and in a hemodynamically stable patient the goal is to define the anatomy precisely to plan repair. CT scan with contrast of the abdomen and pelvis provides a comprehensive view: exact aneurysm size, extent, involvement of renal and iliac arteries, and presence of mural thrombus or calcification. This level of detail is essential for deciding between endovascular versus open repair and for mapping the surgical approach. While ultrasound can confirm the presence and measure diameter quickly and noninvasively, it lacks the detailed cross-sectional anatomy needed for planning. MRI offers similar information but is slower and less readily available in urgent settings, and angiography is invasive and mainly used when intervention is being performed. In this patient with a 7 cm aneurysm, CT with contrast is the best initial test to guide management.

A pulsatile abdominal mass in an older man points to an abdominal aortic aneurysm, and in a hemodynamically stable patient the goal is to define the anatomy precisely to plan repair. CT scan with contrast of the abdomen and pelvis provides a comprehensive view: exact aneurysm size, extent, involvement of renal and iliac arteries, and presence of mural thrombus or calcification. This level of detail is essential for deciding between endovascular versus open repair and for mapping the surgical approach. While ultrasound can confirm the presence and measure diameter quickly and noninvasively, it lacks the detailed cross-sectional anatomy needed for planning. MRI offers similar information but is slower and less readily available in urgent settings, and angiography is invasive and mainly used when intervention is being performed. In this patient with a 7 cm aneurysm, CT with contrast is the best initial test to guide management.