title: An atypical presentation of aortic rupture: intuition and investigation can avoid disaster.
abstract: BACKGROUND
  Patients with an acute abdomen are a common presentation for those participating in emergency surgery cover. The aetiology of this presentation incorporates the spectrum of organ systems and is often not identified satisfactorily. Nevertheless, certain diagnoses will always  be difficult to make and some presentations can be deceptive. Radiological investigations increasingly play a role in establishing an accurate diagnosis and frequently allow prompt management to be instituted.
  
  
  BACKGROUND
  Patients with an acute abdomen are a common presentation for those  participating in emergency surgery cover. The aetiology of this presentation incorporates the spectrum of organ systems and is often not identified satisfactorily. Nevertheless, certain diagnoses will always be difficult to make and some presentations can be deceptive. Radiological investigations  increasingly play a role in establishing an accurate diagnosis and frequently allow prompt management to be instituted.
  
  
  BACKGROUND
  Ruptured AAA should be considered as a differential diagnosis in all elderly patients presenting with acute severe abdominal pain who may be haemodynamically  stable. Atypical history and examination with inconsistent or equivocal clinical signs should raise the suspicion of aneurysm, particularly in elderly men with known arterial disease. There should be a low threshold for both requesting and justifying definitive imaging (ie CT) in such cases  if a catastrophic outcome through misdiagnosis is to be avoided.
authors: Department of Surgery, Lister Hospital, Stevenage, UK. taimur.shah@doctors.org.uk
authors: T T
authors: TT
authors: Shah
authors: P
authors: P
authors: Herbert
authors: T
authors: T
authors: Beresford
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging*; D001019:Aortic Rupture / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D006552:Hernia, Inguinal / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D012187:Retroperitoneal Space; D014057:Tomography, X-Ray Computed