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: Read the clinical picture.
The patient is 60 years old, has high blood pressure, and has a fusiform (spindle shaped, uniform) swelling of the abdominal aorta. This is the classic picture of an abdominal aortic aneurysm (AAA).

Step 2: Recall the usual cause of AAA.
Most abdominal aortic aneurysms, especially fusiform ones in an elderly hypertensive patient, form because of atherosclerosis. Fatty plaques build up in the aortic wall, weaken the middle layer, and the artery bulges out over the years. Age, smoking, and high blood pressure all speed this process up.

Step 3: Check why Marfan's syndrome does not fit.
Marfan's syndrome is a connective tissue disorder that weakens the aortic wall through cystic medial necrosis, but it mainly affects the ascending (thoracic) aorta and causes aneurysms at a much younger age, not a 60 year old with a fusiform abdominal swelling.

Step 4: Check why syphilis does not fit.
Syphilitic aortitis damages the vasa vasorum of the aorta and classically causes a saccular aneurysm of the ascending aorta or arch, not the abdominal aorta. This diagnosis has also become rare since antibiotics came into use.

Step 5: Check why cystic medial necrosis does not fit.
Cystic medial necrosis is the tissue change seen in Marfan's syndrome and related disorders, and it too points to the thoracic aorta, not a fusiform abdominal aneurysm in a hypertensive elderly patient.

Step 6: Final answer.
The most probable cause of a fusiform abdominal aortic aneurysm in a 60 year old hypertensive patient is atherosclerosis.