Aneurysm of the Abdominal Aorta

A 76-year-old man was admitted to the intensive care unit with unstable angina pectoris of Braunwald class IIIB. He was known to have hypertension, which was poorly controlled with medication. Physical examination revealed a pulsating mass in the lower abdomen that was suggestive of an aortic aneurysm. An echocardiographic study with a small, hand-held ultrasound device (SonoHeart, SonoSite Inc) showed an abdominal aortic aneurysm containing thrombotic material (Figure 1). His troponin T level was elevated, and he underwent coronary arteriography, which showed a high-grade stenosis at the bifurcation of left anterior descending artery and the first diagonal branch. The lesion was dilated during the same session, with direct stenting of both branches. Figure 1. Transverse image of the aneurysm of the abdominal aorta (56 mm in diameter), which contains a large thrombus (TR). The …