Annals of Vascular Surgery

, Volume 2, Issue 2, pp 145–149 | Cite as

Symptomatic abdominal aortic aneurysm misdiagnosed as nephroureterolithiasis

  • Edgar Borrero
  • Luis A. Queral
Original Articles


From January 1977 through December 1986, 134 patients with symptomatic AAAs were examined in the emergency room; 24 patients (mean age 72.4 years) had an initial misdiagnosis of “nephrolithiasis.” Ten patients had the correct diagnosis of a ruptured AAA established within five hours of the initial examination and were promptly taken to surgery. Fourteen patients had delay greater than five hours while extensive diagnostic evaluations were performed (intravenous pyelograms in 12, computerized tomographic scans in 7, ultrasonography in 6). All patients underwent emergency surgery and six patients operated upon within five hours of initial examination survived. All patients who had extensive diagnostic evaluation lasting more than five hours died. The only diagnostic procedure that definitively established a ruptured aneurysm in all cases was the CT scan. In patients with confusing physical and laboratory findings but in whom the diagnosis of a ruptured AAA is entertained, an emergency CT scan is recommended as the diagnostic procedure of choice.

Key Words

Abdominal aortic aneurysms Renal colic Nephroureterolithiasis Kidney stones 


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  1. 1.
    FITZGERALD JF, STILLMAN RM, POWERS JC. A suggested classification and reappraisal of mortality statistics for ruptured atherosclerotic infrarenal aortic aneurysms.Surg Gynecol Obstet 1978;146:344.PubMedGoogle Scholar
  2. 2.
    JOHNSON G, MCDEVITT NB, PROCTOR HJ, MANDEL SR, PEACOCK JB. Emergent or elective operation for symptomatic abdominal aortic aneurysm.Arch Surg 1980;115:51–53.PubMedGoogle Scholar
  3. 3.
    BICKERSTAFF LK, HOLLIER LH, VAN PEENEN HJ, MELTON U, PAIROLERO PC, CHERRY KJ. Abdominal aortic aneurysms: The changing natural history.J Vase Surg 1984;1:6–12.CrossRefGoogle Scholar
  4. 4.
    KHAW H, VIKROM SS, CRAIGHEAD CC, BATSON RC. Ruptured abdominal aortic aneurysm presenting as symptomatic inguinal mass: report of six cases.J Vase Surg 1986;4:384–389.CrossRefGoogle Scholar
  5. 5.
    FORLAND M. Nephrology. New York: Medical Examiners Publ. Co. 1977:274–279.Google Scholar
  6. 6.
    HEPTINSTALL RH. Pathology of the Kidney. Boston: Little, Brown, 1983:1621–1627.Google Scholar
  7. 7.
    ATSMAN A, DEVRIES A, FRANK M. Uric acid lithiasis. Amsterdam: Elsevier. 1963.Google Scholar
  8. 8.
    CLAYTON MJ, WALSH JW, BREWER WH. Contained rupture of abdominal aortic aneurysms: sonographic and CT diagnosis.AJR 1982;138:154–156.PubMedGoogle Scholar
  9. 9.
    SAGEL SS, SIEGEL MJ, STANLEY RJ, JOST RG. Detection of retroperitoneal hemorrhage by computed tomography.AJR 1977;129:403–407.PubMedGoogle Scholar
  10. 10.
    ROSEN A, KOROBKIN M, SILVERMAN PM, MOORE AV, DUNNICK N. CT diagnosis of ruptured abdominal aortic aneurysm.AJR 1984;143:265–268.PubMedGoogle Scholar
  11. 11.
    MERCURIAS-TAYLOR LA, KURER MHJ. Haematuria and abdominal aortic aneurysm.J Cardiovasc Surg 1986;27:565–567.Google Scholar
  12. 12.
    GRAHAME JW, DOWNS AR. Ruptured abdominal aortic aneurysm presenting with gross haematuria.J Urol 1971;106:628–630.PubMedGoogle Scholar
  13. 13.
    GOURDIN FW, SALAM AA, SMITH RB, PERDUE GD. Aortovenous fistulas due to ruptured infrarenal aortic aneurysms: experience with six cases.South Med J 1982;75:913–916.PubMedGoogle Scholar
  14. 14.
    DARLING RC, LINTON RR. Aneurysm of the abdominal aorta with rupture into the inferior vena cava.N Engl J Med 1962;267:974.PubMedGoogle Scholar
  15. 15.
    DARDIK H, DARDIK I, STROM MG, ATTAI L, CARNEVALE N, VEITH FJ. Intravenous rupture of arteriosclerotic aneurysms of the abdominal aorta.Surgery 1976;80:647–651.PubMedGoogle Scholar
  16. 16.
    SUZUKI M, COLLINS GM, BASSINGER GT. Aorto-left renal vein fistula: an unusual complication of abdominal aortic aneurysm.Ann Surg 1976;184:31–34.CrossRefPubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 1988

Authors and Affiliations

  • Edgar Borrero
    • 1
  • Luis A. Queral
    • 1
  1. 1.Department of Surgery, Division of Vascular SurgeryUniversity of Maryland Medical SystemBaltimore

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