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ABSTRACT
The rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event. Misdiagnosis by first-contact emergency physicians remains a serious concern. Varied and frequently nonspecific presentations lead to erroneous diagnostic impressions and cause significant delays in definitive intervention. We report the case of a 73-year-old man with a ruptured AAA presenting with isolated acute right hip pain without any classical features such as truncal pain or hypotension. Despite major advances in imaging and definitive treatment, a heightened awareness among emergency physicians remains the only effective means of improving detection and thereby survival.
Keywords: ruptured abdominal aoritc aneurysm, diagnosis, computerized tomogrpahy scan, acute hip pain
RÉSUMÉ
La rupture d'un anévrisme de l'aorte abdominale a de graves conséquences, et la pose d'un mauvais diagnostic par les médecins d'urgence au premier contact demeure très préoccupante. Les motifs de consultation à l'urgence sont variés et fréquemment vagues, ce qui occasionne des impressions diagnostiques erronées et retarde considérablement l'intervention définitive. Nous rapportons un cas de rupture d'anévrisme de l'aorte abdominale chez un homme de 73 ans s'étant présenté à l'urgence avec une douleur aiguë isolée à la hanche droite sans symptômes types tels que des douleurs thoraciques ou de l'hypotension. Malgré les avancées de la science en matière d'imagerie médicale et de traitements définitifs, une plus grande sensibilisation des médecins d'urgence demeure l'unique moyen d'améliorer la détection de cette affection et, par le fait même, la survie des patients.
Introduction
Ruptured abdominal aortic aneurysms (rAAAs) are a substantial health care burden in developed countries and are the thirteenth leading cause of death in the United States.1 Approximately 1 in 25 adults over 65 years of age harbour AAAs.2 Population-based studies have indicated that the incidence of rAAA has almost tripled in the last 30 years.2,3 Misdiagnosis by first-contact practitioners has been shown to be the most significant factor in delay to surgery, with as many as 60% of cases incorrectly diagnosed.4-6 This is subsequently reflected in the strikingly high overall mortality rate; up to 85% has been reported in some studies.1 Numerous investigations have suggested that expeditious diagnosis of an AAA, even if it has ruptured, offers the best hope for patient survival.7 In our patient, rAAA was heralded only by isolated hip pain.
Case report
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