The asymptomatic mass may be detected by deep manual palpation of the central abdomen below or above the umbilicus. The majority of aneurysms are not detected
by palpation and they are particularly obscured by body habitus. Occasionally mild abdominal pain radiating to the low back occurs. This mild pain usually has a constant, gnawing quality and may last for hours or days. Pain of new onset or progressive increase in the intensity of pain may indicate expansion of the aneurysm or impending rupture. The rupture of an abdominal aneurysm is usually accompanied by increasing severity of pain, lower blood pressure, hypotension, and a pulsatile mass in the central abdomen. The patient is usually anxious, sweaty, and in distress.
A simple ultrasound of the abdomen detects all abdominal aneurysms and gives a good estimate of their size. Screening is recommended mainly in patients at risk. The normal diameter of the aorta is 1.8–2 cm. Approximately 10% of men have an aortic diameter of more than 2.9 cm by age 65. An aneurysm is indicated by an aortic diameter of 3 cm or greater. Aneurysms are significant when they are greater than 4 cm in diameter and from this stage must be followed closely every six months with ultrasonography. A CT is even more accurate and can determine the size of aneurysms to within a diameter of i 2 mm. Aneurysms more than 4 cm have less than a 2% risk of rupture, but those larger than 5.5 cm have a more than a 20% risk of rupture within 2 years; the risk is considered relatively low with aneurysms less than 5 cm.

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