The mother of all incidental findings

The nice thing about being on call is when you get an admit for chest pain, rule out MI. The work up is the same every time and it's an easy in and out, usually less than 24 hour hospital stay.

Every now and then though, you get something interesting, and that's the enjoyable part about medicine sometimes. You'll get something that surprises even yourself. My last call, I was examining a chest pain rule out patient and I found an undiagnosed abdominal aortic aneurysm. It was hard to miss: it was large and in charge. And I informed the patient of the risk of rupture and such.

But what really shocked me is that she's known that it was there for months now, and in that time, she's seen doctors and no one's caught this before. I mean, it's bouncing out of this patient's abdomen and how can I have been the only person to catch it? It's certainly not causing the chest pain. The patient's lucky that there was non-cardiac chest pain needing R/O MI so that we could find this AAA.

Of course, lucky is a subjective term. Risk of rupture is big and the surgery of AAA is about as high risk as they come. I am guessing that it's probably the riskiest 'normal' surgery, elective or not. So maybe there's something to living in blissful ignorance and dropping dead. So you tell me who's lucky.

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