An 86 year old male presented to a community hospital with syncope. He had documented syncope in the past felt to be related to chronic orthostatic changes but still remained on beta blocker therapy. He suffered enough trauma to result in head injury, finger dislocation and rib fractures. Abdomen was quiet. After attending to his immediate injuries, reducing the finger dislocation and getting a CT head, we undertook a FAST scan. He had pristine vitals. On scanning the abdomen, there was a very small aorta but at the umbilicus no bifurcation was seen. More distally, though, at the pelvis, a cystic round structure appeared, somewhat contiguous to the bladder, but past the point where you would have expected the bifurcation to be. The patient was admitted overnight and the hospitalist was contacted to resume care in the morning. Would you have accepted this admission or would you have asked for AAA to be ruled out by CT, given the FAST findings? Screening labs were normal.
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