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A 69 year old African women presented with a one year history of vague abdominal and lower back pains. Over recent months she had become more aware of a pulsatile mass in the left side of her abdomen. Apart from a history of poorly controlled hypertension she was otherwise fit and well and had never been to hospital before.
On examination a large pulsatile mobile mass filling the left side of her abdomen was noted.
Computed tomography (fig 1) confirmed the presence of 15 cm infrarenal abdominal aortic aneurysm extending to the bifurcation. The radiological findings of a large aneurysm with little thrombus were highly suggestive of intimomedial mucoid degeneration. The aneurysm (fig 2) was successfully repaired with a straight Dacron interposition graft and the patient made an uneventful recovery. Histological examination of the aneurysm wall confirmed the diagnosis.
Intimomedial mucoid degeneration is a well described cause of aneurysmal disease occurring almost exclusively in black African women.1 These aneurysms often reach large sizes before rupture and characteristically are noted to have scant thrombus and clot within the aneurysm sac. Surgical repair can be challenging, as the soft arterial wall does not hold sutures well and bleeding complications occur in some patients as a result of primary fibrinolysis.