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Endgames Picture Quiz

A man with a palpable abdominal mass and night sweats

BMJ 2014; 348 doi: (Published 24 April 2014) Cite this as: BMJ 2014;348:g2834
  1. Amanda Catherine Jewison, radiology registrar1,
  2. Vicky Tilliridou, final year medical student2,
  3. Emily Skelton, sonographer1,
  4. David C Howlett, consultant radiologist1,
  5. George Evans, consultant vascular surgeon3
  1. 1Department of Radiology, Eastbourne District General Hospital, Eastbourne BN21 2UD, UK
  2. 2Brighton and Sussex Medical School, Brighton, UK
  3. 3Department of Vascular Surgery, Eastbourne District General Hospital, Eastbourne, UK
  1. Correspondence to: A C Jewison ajewison{at}

A 78 year old man presented with an eight week history of left sided abdominal pain and back pain, associated with anorexia, 3 kg weight loss, and night sweats. He was previously well, had no medical history of note, was taking no regular drugs, and was an ex-smoker.

On physical examination, he was afebrile, baseline observations were normal, and peripheral pulses were present. Cardiorespiratory assessment was unremarkable. His abdomen was soft, but there was a tender non-pulsatile palpable central mass at the level of the umbilicus. Blood results showed a normochromic, normocytic anaemia with haemoglobin 92 g/L (reference range 130-180), erythrocyte sedimentation rate 75 mm in the first hour (0-22), and C reactive protein 15 mg/L (<3; 1 mg/L=9.52 nmol/L).

Initial chest and abdominal radiographs showed no abnormalities so a computed tomogram of the abdomen and pelvis was performed (fig 1).

Fig 1 Axial contrast enhanced computed tomogram at the level of the iliac crest


  • 1. What does the computed tomogram show?

  • 2. What is the diagnosis?

  • 3. How should this patient be managed?


1. What does the computed tomogram show?

Short answer

The computed tomogram shows aneurysmal dilation of the abdominal aorta, with a thickened …

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