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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Misleading presentation of ruptured abdominal aortic aneurysm and the role of point-of-care ultrasound for diagnosis

Abstract

If not recognized and treated early enough, the rupture of abdominal aortic aneurysm (rAAA) embodies a devastating medical emergency. It is associated with high morbidity and mortality which can reach up to 100 % in untreated individuals. Patients are usually hypotensive, shocked, complain of pain in the abdomen or back, and can have a palpable pulsatile abdominal mass. rAAA can be misdiagnosed due to patient’s comorbidities, site of rupture, or unusual presentations. Unusual clinical presentations include transient lower limb paralysis, right hypochondrial pain, groin pain, testicular pain, iliofemoral venous thrombosis, and others. When ruptured abdominal aneurysm is suspected an emergency ultrasound should be performed. In this article we are going to present a patient with unusual presentation of ruptured abdominal aneurysm and the importance of point-of-care ultrasound in similar cases.

Key words: abdominal aortic aneurysm, rupture, point-of-care ultrasound

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A hematoma confined to the center of the abdomen

Abstract

Spontaneous rupture of a hepatocellular carcinoma is a rare and lethal complication in the emergency department. A caudate lobe hepatoma rupture is even rarer. It can be treated with vascular embolization, surgical intervention or supportive care. A 70-year-old woman with underlying hepatocellular carcinoma presented to our emergency department with severe abdominal pain encompassing the entire region for half a day. Abdominal computer tomography scans with and without contrast medium revealed a large hematoma confined to the lesser sac of the abdomen. It was initially diagnosed as a ruptured aneurysm. A ruptured caudate lobe hepatoma with acute hemorrhage into the lesser sac was diagnosed after reviewing and discussing the imaging findings with the radiologist. The patient was treated with supportive care without vascular embolization or surgical intervention because there was no imaging evidence of active contrast extravasation and the vital signs were within the normal range. After reviewing the literature, our case appears to be the second only case treated with supportive care and discharged without complications.

Keywords: hepatoma, hepatocellular carcinoma, caudate, rupture, peritonitis

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