Ultrasound Diagnosis of Ruptured Abdominal Aortic Aneurysm Mimicking Stroke

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Abdominal aortic aneurysm (AAA) is a potentially life-threatening vascular condition that commonly presents with hemodynamic instability, abdominal or back pain, and a pulsating abdominal mass. Incidence increases with age, history of smoking, and atherosclerotic disease. Mortality rate has been estimated to be approximately 80-90%. Over one-third of AAAs are misdiagnosed, commonly as renal colic, diverticulitis, and gastrointestinal hemorrhage, leading to delays in definitive care. Point-of-care ultrasound (POCUS) has become invaluable in the emergency department for the assessment of unstable patients due to its portability and ease of use. We present a patient who arrived as a code stroke but was ultimately found to have a AAA emphasizing the diagnostic challenges of atypical presentations and the utility of POCUS to guide decision-making in critically ill patients.

A 76-year-old male with hypertension, type 2 diabetes, hyperlipidemia, GERD, and 21 pack-year smoking history was transported to Butterworth Emergency Department as a code stroke with last known well of 6:45 AM. On arrival, he had left facial droop and left-sided weakness with a blood pressure 101/64 mmHg and stable vital signs. He reported abdominal tenderness with mottling on exam. Neurologic evaluation revealed an NIH Stroke Scale score of 10 with partial hemianopia, facial droop, left upper extremity paralysis, lower extremity drift, and dysarthria. Point-of-care blood glucose was 391 mg/dL. Initial POCUS had limited utility due to equipment malfunction. Stroke protocol CT studies were ordered with a CT chest, abdomen, pelvis to rule out aortic dissection. EKG showed a sinus rate of 62 beats per minute with ST elevations in leads II, III, and aVf.

This case illustrates an atypical presentation of abdominal aortic aneurysm. While neurologic deficits caused by ruptured AAA are rare, it is important not to narrow the differential too quickly. Additionally, it underscores the utility of POCUS in the diagnosis of unstable, undifferentiated patients. Ultrasound is able to provide immediate, non-invasive evaluation and can easily be integrated into emergency algorithms, unlike other imaging studies. Promoting use of early ultrasound on unstable, undifferentiated patients in the emergency room can save time and lives.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1937

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