70 year old man has abdominal pain with mass in abdomen. Angiography reveals aneurysm of aoa. Most likely cause is –
**Core Concept**
The underlying condition in this patient is an aneurysm of the abdominal aorta (aorta), which is a localized dilation of the aortic wall, typically resulting from chronic degeneration of the media layer. This condition is often associated with aging.
**Why the Correct Answer is Right**
The most likely cause of an aneurysm of the abdominal aorta in a 70-year-old man is atherosclerosis. Atherosclerosis is a chronic inflammatory disease characterized by the accumulation of lipids, cholesterol, and inflammatory cells in the arterial wall, leading to the weakening of the aortic wall and subsequent aneurysm formation. The pathophysiology involves the degradation of the elastin and collagen fibers in the aortic media, making the aorta more susceptible to rupture.
**Why Each Wrong Option is Incorrect**
* **Option A:** Aneurysm of the abdominal aorta is less common in patients with Marfan syndrome, which primarily affects the ascending aorta. Although Marfan syndrome can cause aortic aneurysms, it is not the most likely cause in this scenario.
* **Option B:** Traumatic injury to the aorta can cause aneurysm formation, but this is more likely to occur in younger patients involved in high-impact accidents.
* **Option D:** Infections such as syphilis or mycotic aneurysms can cause aortic aneurysms, but these are relatively rare and not the most common cause in an elderly patient.
**Clinical Pearl / High-Yield Fact**
Atherosclerosis is a major risk factor for abdominal aortic aneurysms, and patients with a history of smoking, hypertension, and hyperlipidemia are at increased risk.
**Correct Answer: C. Atherosclerosis. Atherosclerosis is the most likely cause of an aneurysm of the abdominal aorta in a 70-year-old man.**