A Tender Pulsatile Epigastric Mass is NOT Always an Abdominal Aortic Aneurysm: A Case Report and Review of Literature.

Of greatest concern in the assessment of a patient with a tender pulsatile abdominal mass is the possibility of a leaking or ruptured Abdominal Aortic Aneurysm (AAA). Other serious abdominal pathologies may demonstrate the same clinical signs but require entirely different treatments. Even amongst patients with proven abdominal aortic aneurysms CT imaging findings may influence the timing and nature of surgery and provide useful prognostic information. We present a case in which a large abdominal tender pulsatile mass was not aortic in origin. The patient had a significantly large tender congested liver associated with right side heart failure due to progressive tricuspid valve regurgitation. We have also discussed the differential diagnoses which may mimic abdominal aneurysms and discussed the role of imaging in resolving these problems.