Case 221


J.C.M., 81 years old, male, complains of persistent, stabbing pain in the right lower quadrant of the abdomen without signs of peritonitis. He is a smoker, smoking history of 140 pack-years, with hypertension, CKD IIIb and COPD. Previous acute myocardial infaction ten years ago, treated with primary percutaneous angioplasty. On examination: visible and palpable mass in the upper abdomen, pulsatile and painless to palpation (Image 1). An ultrasonography (USG) showed a large abdominal aortic aneurysm. A MRI angiography (Image 2) was requested for surgical planning.

Image 1: Photography of the patient's abdomen in supine position.


Image 2: Magnetic Resonance Imaging (MRI) angiography of the abdomen in coronal view.

Taking into consideration the patient's clinical characteristics and the imaging studies attached, what is the best approach in this case?

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