Question

A 60 year old hypertensive patient comes with abdominal pain and fusiform dilatation of the abdominal aorta. What could be the most probable etiology?

• A. Marfan's syndrome
• B. Syphilis
• C. Atherosclerosis
• D. Cystic medial necrosis

Hint:

Fusiform abdominal aortic aneurysm in an elderly hypertensive patient points to a degenerative wall change from fat plaque build up.

Answer 1

The Correct Option is C

Step 1: Identify the condition.
A spindle shaped (fusiform) bulge of the abdominal aorta with pain in a 60 year old with high blood pressure is an abdominal aortic aneurysm.

Step 2: Think about what damages the aortic wall over decades.
The aortic wall has three layers, and the middle layer gives it strength. Fatty deposits building up inside the wall over many years thin and weaken this middle layer, letting the vessel stretch outward evenly, which produces a fusiform shape. This process is atherosclerosis, and it is worsened by long standing hypertension.

Step 3: Rule out the connective tissue causes.
Marfan's syndrome and cystic medial necrosis weaken the aorta from birth through a faulty connective tissue protein (fibrillin), so the aneurysm shows up early in life and almost always in the chest portion of the aorta, not here.

Step 4: Rule out infection.
Syphilis was once a well known cause of aortic aneurysm, but it attacks the small vessels feeding the aortic wall in the chest, giving a saccular (pouch like) bulge in the ascending aorta, a very different picture from this patient.

Step 5: Match age, site and shape to the right cause.
An elderly, hypertensive patient with a fusiform swelling of the abdominal aorta fits a degenerative, fat plaque driven wall change.
\[ \boxed{\text{Atherosclerosis}} \]