A pulsatile abdominal mass with recurrent urinary tract infections most strongly suggests which condition?

A pulsatile abdominal mass with recurrent urinary tract infections most strongly suggests which condition?

• A. Renal cell carcinoma
• B. Diverticulitis
• C. Abdominal aortic aneurysm
• D. Inguinal hernia

Answer: (C)

A pulsatile abdominal mass points to dilation of the abdominal aorta, an abdominal aortic aneurysm. The aorta runs in the midline of the abdomen, and when its wall weakens and dilates, it often produces a pulse-synchronous mass that can be felt on exam. An AAA may be present without symptoms, but becomes critical if it enlarges or ruptures, which is life-threatening. Recurrent urinary tract infections don’t define the other conditions here, and they don’t explain a pulsatile abdominal mass. Diverticulitis causes left lower quadrant pain with fever and leukocytosis, not a pulsatile midline abdominal mass. An inguinal hernia appears as a bulge in the groin, not a pulsatile mass in the abdomen. Renal cell carcinoma can present with a flank mass or hematuria, but a pulsatile abdominal mass in the midsection is most characteristic of an AAA. If this sign is suspected, urgent imaging of the abdomen–pelvis with CT angiography and vascular consultation are the next steps, with management guided by size and symptoms.

A pulsatile abdominal mass points to dilation of the abdominal aorta, an abdominal aortic aneurysm. The aorta runs in the midline of the abdomen, and when its wall weakens and dilates, it often produces a pulse-synchronous mass that can be felt on exam. An AAA may be present without symptoms, but becomes critical if it enlarges or ruptures, which is life-threatening. Recurrent urinary tract infections don’t define the other conditions here, and they don’t explain a pulsatile abdominal mass.

Diverticulitis causes left lower quadrant pain with fever and leukocytosis, not a pulsatile midline abdominal mass. An inguinal hernia appears as a bulge in the groin, not a pulsatile mass in the abdomen. Renal cell carcinoma can present with a flank mass or hematuria, but a pulsatile abdominal mass in the midsection is most characteristic of an AAA.

If this sign is suspected, urgent imaging of the abdomen–pelvis with CT angiography and vascular consultation are the next steps, with management guided by size and symptoms.