A 62 year old man has had episodes of abdominal pain over the past month. He has also had episodes of chest pain in the past 5 years. On physical examination, bowel sounds are present. There is a midline pulsatile mass. Dorsalis pedis and posterior tibial pulses are barely palpable. An abdominal CT scan reveals a 6 cm diameter enlargement of the abdominal aorta below the renal arteries that is partially filled with thrombus. Bright areas representing calcifications are seen in the aortic wall. Which of the following laboratory test findings is he most likely to have:
A Anti-streptolysin O titer of 1:512
B Plasma homocysteine of 20 micromol/L
C HDL cholesterol of 65 mg/dL
D Coxsackie B serologic titer of 1:80
E Positive serum VDRL
(B) CORRECT. He has an abdominal atherosclerotic aneurysm at risk for rupture because of the size. Complications of atherosclerosis are more likely in persons with risk factors such as low HDL cholesterol and high homocysteine.
M.D., PGY-3 Internal Medicine