A small aneurysm seemingly ballooned in size and unexpectedly killed a woman.
Violet (Sue) Livene Nelson, 80, collapsed in her home in Wokingham, Berkshire, England, in 2016.
2012 Diagnosis of
Small Abdominal Aortic Aneurysm
As of March 2012 the dilation measured just 3.6 cm. Her general physician did not refer her to a vascular specialist.
If you’ve been diagnosed with even the smallest abdominal aortic aneurysms, or a “dilation,” “dilatation” or “enlargement,” then you absolutely should seek out a consultation with a specialist, which would be a vascular surgeon.
Nelson was only instructed to come back to her primary doctor for annual reviews to check on the growth. She complied for 2013 and 2014.
How fast did this
abdominal aortic aneurysm grow?
In 2013 it had grown minimally, to 3.7 cm. Oddly, in 2014 the scan showed 3.4 cm.
The protocol at the Wokingham clinic at the time was that 5.5 cm was the cutoff point for which a patient would automatically be referred to a specialist.
This is why the general practitioner never referred her, thinking she was in a safe zone with the 3.6, 3.7 and 3.4 cm measurements.
So based on this information so far, it may seem that actually, it’s NOT crucial to immediately seek out a vascular physician if you’re told you have an AAA measuring three point something centimeters, or even something in the low four range.
But this story takes an unexpected turn. Nelson, for reasons nobody will ever know, failed to make follow-up appointments for 2015 and 2016. She also had never told her husband about the 2012 diagnosis.
Her husband had told the coroner that in the several days preceding her death, she had not been well, but on the morning of her fatal collapse in the kitchen, she had seemed better.
Did the abdominal aortic aneurysm
really grow THAT fast?
A post-mortem report showed that the AAA was about 10 cm. How could the abdominal aortic aneurysm, measuring only 3.4 cm in 2014, grow fast enough to swell up to 10 cm only three years later?
The 10 cm bulge turned out to be much higher up in the thoracic cavity than was the original much smaller bulge that was found in 2012.
The coroner, Peter Bedford, consulted with vascular surgeon Jack Collin, MD, about this odd situation.
Dr. Collin pointed out that a general practitioner would not have known to refer a patient to a specialist over a 3.6 cm bulge, especially since two years later it had apparently shrunk.
However, a referral could have saved her life, because, as Dr. Collin stated in the report, a specialist would have conducted a more thorough scan.
“Someone with more specialist knowledge would have suspected that the suprarenal abdominal aortic aneurysm was in fact the lower end of a much larger aneurysm,” stated Dr. Collin.
Bedford, the coroner, said that a general practitioner would not have had the knowledge to suspect that what appears to be a small abdominal aortic aneurysm could be, in fact, the lower end of a bigger and life threatening AAA.
As a result of this investigation, the Wokingham Medical Practice has now implemented a system in which any-size AAA nets a referral to a vascular specialist.