A Noncompliant Construction Worker With a Pulsating Abdomen

Muthunivas Muthuraj; Rahul R. Borra; Panagiotis Iakovidis, MD


November 22, 2021

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


An 83-year-old man reports occasional dull pain in his abdomen; however, he is currently asymptomatic. He denies exacerbation of the pain upon eating or drinking. He notes that his most recent bouts of pain have been more severe than usual.

For several years, he has also had a constant pulsating sensation in his abdominal region that varies in severity. The pulsations increase in severity when he eats heavy meals or exerts himself physically.

He has a 15-year history of atherosclerosis and hypercholesterolemia, as well as a history of bronchitis and a lipoma that was surgically removed. Despite elevated cholesterol levels and atherosclerosis, he denies any history of coronary artery disease, stroke, aneurysm, or blood clots. Atorvastatin and aspirin have been prescribed for this patient in the past, but he has not been compliant with his medications.

He says that he has not sought regular medical care, notwithstanding his age, because he considers himself healthy. He has not had a recent complete blood cell count, complete metabolic panel, or abdominal imaging study.

The patient states that he smoked one pack of cigarettes a day for 45 years. Despite recommendations, he has not quit smoking. For the past 10 years, he has smoked half a pack a day. Contrary to guidance, his diet remains centered around red meat, such as steak and pork. He states that he consumes alcohol on social occasions and denies any history of illicit drug use. He has remained physically active throughout his life because of his occupation in construction, which he continues to this day.


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