Which finding is described as a late sign of an abdominal aortic aneurysm?

• A. Pulsating abdominal mass
• B. Hypotension
• C. Abdominal tenderness
• D. Back pain

Answer: (B)

A late sign of an abdominal aortic aneurysm is hypotension because it signals rupture with hemorrhagic shock. An AAA can be present for a long time without symptoms, and a pulsatile abdominal mass or abdominal/back pain may appear as the aneurysm enlarges. However, when the aneurysm ruptures, the patient loses blood into the abdominal cavity, leading to a drop in blood pressure and signs of shock. That dramatic fall in perfusion is the late, critical change that indicates rupture. The other findings—pulsatile mass, abdominal tenderness, and back pain—can occur with a non-ruptured, enlarging aneurysm or be non-specific, but they do not by themselves indicate an imminent or ongoing rupture the way hypotension does.