A pulsating abdominal mass usually indicates which of the following conditions?
A. Abdominal aortic aneurysm
B. Enlarged spleen
C. Gastric distention
D. Gastritis
Correct Answer: A. Abdominal aortic aneurysm
The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in an abdominal aortic aneurysm. The finding, however, can be normal for a thin person.
Option B: An enlarged spleen does not cause a pulsation. It is usually palpable upon physical examination. Most clinically significant AAAs are palpable upon routine physical examination; however, the sensitivity of palpation depends on the experience of the examiner, the size of the aneurysm, and the size of the patient. In one study, 38% of AAA cases were detected on the basis of physical examination findings, whereas 62% were detected incidentally on radiologic studies obtained for other reasons.
Option C: Gastric distention does not cause pulsation. Gastric distension causes progressive shortening of the abdominal length of the LES and a reduction in its pressure. The process exposes the effaced mucosa and sphincter to acid gastric juice.
Option D: Gastritis does not indicate pulsation. The physical examination findings are often normal, with occasional mild epigastric tenderness. The examination tends to exhibit more abnormalities as the patient develops complications in relation to gastritis.