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Clinical Crossroads
July 22/29, 1998

A 75-Year-Old Woman With an Abdominal Aortic Aneurysm and Emphysema

Author Affiliations

Dr Goldman is Julius R. Krevans Distinguished Professor and Chairman, Department of Medicine, and Associate Dean for Clinical Affairs, School of Medicine, University of California, San Francisco.


Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.

JAMA. 1998;280(4):366-372. doi:10.1001/jama.280.4.366

DR PARKER: Mrs H is a 75-year-old woman weighing the risks and benefits of proceeding with an elective surgical repair of an abdominal aortic aneurysm. She lives in the greater Boston area with her husband and has her health care insurance through Medicare.

Mrs H's physicians have followed the size and extent of her thoracic and abdominal aortic aneurysms carefully for several years. By angiogram, the aneurysm involved the origin of the celiac and superior mesenteric arteries, down to the level of the renal arteries. An arteriogram in 1992 revealed a diameter of the thoracic section at 5 cm to 6 cm. An ultrasound in 1995 showed an increase to 6.5 cm. The abdominal aortic aneurysm was measured at approximately 5 cm. By 1996, a magnetic resonance angiogram estimated the thoracic aneurysm at 9 cm, and a computed tomographic (CT) scan estimated its size at 8×12 cm. Mrs H remained asymptomatic during this period with regard to the dilated aorta.