Symptoms of Abdominal Aortic Aneurysm

Abdominal aortic aneurysm (AAA) is a pathological dilation of the abdominal aorta—not a true neoplasm. Patients may present with an abdominal mass, abdominal pain, lower-limb embolism, or duodenal bleeding. Therefore, if an abdominal mass is detected—especially when accompanied by recurrent hematochezia or abdominal pain—an abdominal CT scan is strongly recommended. Although AAA is not a malignant tumor, it carries significant risks: physical examination may reveal a vascular bruit, and in severe cases, rupture can occur, leading to life-threatening hemorrhage. So, what are the clinical manifestations of abdominal aortic aneurysm? Below, we address this question.

Symptoms of Abdominal Aortic Aneurysm

1. Pain

Pain is a common pre-rupture symptom, typically localized to the periumbilical region or upper-to-mid abdomen. When the aneurysm invades the lumbar vertebrae, patients may experience low back or sacral pain. Sudden onset of severe abdominal or lumbar pain often signals imminent rupture. The most important physical sign is a pulsatile, expansile abdominal mass—usually located in the periumbilical or upper-to-mid abdominal region along the midline. This mass is generally palpable unless the patient is obese; it may be tender and associated with fine tremors, and a systolic bruit may be auscultated.

2. Rupture

Rupture is a life-threatening complication and its initial presentation. The most common type is rupture into the peritoneal cavity; however, rupture into the retroperitoneal space occurs more frequently, resulting in slower, more insidious hemorrhage. Abdominal pain and hypovolemic shock may persist for several hours to days, allowing time for medical intervention in many cases. Occasionally, bleeding is contained, presenting with abdominal pain, fever, and mild-to-moderate blood loss—yet such cases carry high risk of subsequent re-rupture. Rarely, the aneurysm ruptures into the inferior vena cava, forming an aortocaval fistula, which manifests as a continuous murmur, high cardiac output, and eventual heart failure.

3. Palpable Mass

A pulsatile abdominal mass is the most characteristic physical finding in AAA. Most patients have a palpable, pulsatile mass in the abdomen—typically non-tender, though tenderness may occasionally be present, along with an audible bruit. Such masses usually lie above or at the level of the umbilicus, bilaterally along the midline. If the distance between the superior margin of the aneurysm and the costal margin accommodates two fingers, it often indicates an infrarenal AAA. During physical examination, bilateral lower-limb arterial pulses and perfusion should be assessed, and venous return should also be evaluated.

The above outlines the key clinical symptoms of abdominal aortic aneurysm. We hope this information is helpful to you.