A pulsatile mass in the periumbilical area with back pain most strongly suggests which condition?

• A. Gastric ulcer
• B. Pancreatic cancer
• C. Abdominal aortic aneurysm
• D. Umbilical hernia

Answer: (C)

A pulsatile abdominal mass located near the umbilicus most strongly points to an abdominal aortic aneurysm. The aorta runs retroperitoneally in that region, and when it dilates, you can feel a pulse in the abdomen that may be described as pulsatile. Back pain often accompanies an enlarging aneurysm as it stretches surrounding tissues or irritates adjacent structures. This combination—pulsatile periumbilical mass plus back pain—fits an AAA far more than other abdominal/GI conditions.

Gastric ulcers cause epigastric pain and sometimes bleeding but don’t produce a pulsatile abdominal mass. Pancreatic cancer can refer pain to the back and cause weight loss, but it doesn’t create a pulsatile abdominal mass. An umbilical hernia presents as a protruding bulge at the umbilicus that worsens with coughing or straining and is not characteristically pulsatile or associated with back pain.