An unstable patient with a pulsatile mass: proceed immediately to the OR?

This is a case report of a patient who presented to the Emergency Department with abdominal pain, unstable vital signs, and a pulsatile abdominal mass. Current recommendations are to limit diagnostics and send the patient to the operating room as soon as possible for laparotomy because even if an abdominal aortic aneurysm rupture is not found, most of these patients will end up having pathology for which surgery will ultimately be needed. This case report describes a patient who did not have a surgical cause for her presentation, but rather, severe tricuspid regurgitation and, consequently, significant pulsatile hepatomegaly accounting for the finding of a pulsatile abdominal mass. A brief overview of how such patients should be managed is presented as well as a recommendation that urgent bedside sonography be undertaken before proceeding to the operating room.