Pulsatile Abdominal Mass

When a pulsatile abdominal mass is found, the patient’s medical and surgical histories, the location of the mass, and the associated symptoms are essential clues to formulating a diagnostic and treatment plan. The underlying condition may range in severity from benign to life threatening. Further evaluation is imperative because, depending on the source of the pulsatile mass, immediate transport to the operating room or endovascular suite may be necessary. Here, the evaluation and management of patients presenting with pulsatile abdominal masses in both the emergent and elective settings are discussed. The careful selection of patients appropriate for repair, an evidence-based approach to imaging and risk stratification, and new techniques in resuscitation of and endovascular or hybrid approaches to patients with ruptured aneurysms are emphasized. Figures show a diagnostic and treatment algorithm for the patient presenting with a pulsatile abdominal mass, computed tomography (CT) image of a pulsatile abdominal mass distorting the anterior abdominal wall, CT image of an isolated right iliac artery aneurysm, CT image of a previous endovascular repair with kinking of the left iliac li