ABSTRACT
Paciente masculino, 57 anos, hipertenso, etilista, ex-tabagista, com quadro anterior de acidente vascular encefálico por aneurisma em artéria cerebral média em 1998. No ano de 2013, com sintomas de cansaço e mialgias, pensava estar com dengue, não suportando ficar de pé devido às dores em membros inferiores. Concomitantemente, apresentou paralisia facial central e perda da força motora em membro inferior direito, sendo internado com diagnóstico de acidente vascular encefálico isquêmico. Constatou-se também isquemia subepicárdica lateral alta ao eletrocardiograma, apesar de o paciente se apresentar oligossintomático sob o ponto de vista cardiovascular, sendo submetido a diversas investigações angiográficas e angiotomográficas, possibilitando o diagnóstico do aneurisma de aorta abdominal infrarrenal silencioso. As inespecificidades e o quadro clínico assintomático da doença são dificuldades comumente encontradas no diagnóstico, tornando-se fundamental a utilização de técnicas complementares de alta complexidade para definição do diagnóstico por imagem. São essenciais as atualizações e pesquisas sobre o presente tema, aumentando a acurácia e a precocidade do diagnóstico, e diminuindo, portanto, a morbimortalidade dos pacientes portadores de aneurisma de aorta abdominal.
Abdominal aortic aneurysm (AAA) is an irreversible aortic dilatation below renal arteries, usually, asymptomatic, showing high morbidity and mortality, becoming relevant this clinical report. Abdominal aortic aneurysm is particularly difficult to diagnose. This study aims to describe in detail the diagnostic process in several levels: syndromic functional, anatomical and etiological and commonly difficulties encountered. Male, 57 year-old, hypertensive, alcoholic and smoker with a previous history of stroke due to middle cerebral artery aneurysm in 1998. In the year 2013 with symptoms of fatigue and muscle pain, thought to have dengue, he wasn't supporting to stand up due to a pain in the lower limbs (LL). Simultaneously he suffered central facial paralysis and loss of motor strength in the right leg. Therefore he was hospitalized with a diagnosis of a new stroke. He showed also high lateral subepicardial ischemia on electrocardiogram, although he had a few atipical cardiovascular symptoms. The patient was submitted to diverse angiographic and angiotomographies investigations, allowing the precise diagnosis of a silent infrarenal Abdominal aortic aneurysm . The authors present a clinical case of infrarenal Abdominal aortic aneurysm, reporting diferentt clinical procedures. The report also discusses the endovascular therapeutic approach and the clinical screening and diagnostic methods. The unspecific and asymptomatic clinical picture of this disease were commonly found difficulties in diagnosis, becoming essential the use of complementary techniques of high definition for diagnostic imaging. Updates are required and research on this topic increasing the accuracy for an early diagnosis and treatment, reducing therefore the morbidity and mortality of these patients.