This is an abdominal aortic aneurysm which ruptured, evidenced by: hypotension, pulsatile abdominal mass, the guarding and rigidity in the periumbilical region. (Pathoma page 70, FA 2018 page 298) Additional findings would include decreased femoral pulses.
A- Patient is hypotensive/hypovolemic, you probably won't see normal ankle, and brachial indices.
B - Aortic regurgitation is seen in thoracic aortic aneurysms secondary to syphilis, or cystic medial degeneration in marfans/ehler's danlos. Could also be due to aortic root dilatation from aortic dissection.
C/D - both are seen classically in aortic dissection.
Asymmetric radial pulse/blood pressure readings higher in left UE than in right - both mean the same thing seen in Aortic dissection
submitted by โcassdawg(1780)
Pulsatile mass in the abdomen combined with severe abdominal pain, decreased blood pressure, pail and lethargic all point to dissection of an abdominal aortic aneurysm. This would cause decreased femoral pulses due to loss of blood flow to the lower extremities.