Abdominal Aortic Aneurysm: Examination and Diagnosis

00:01 Let me pose a question to you.

00:02 What is the classic presentation for a patient with impending AAA rupture? I'll give you a second to think about this.

00:12 That's right, severe abdominal pain radiating to the back, and potentially a pulsatile mass.

00:18 Now, with the increase of obesity, our patients are more and more difficult to diagnose in terms of pulsatile masses.

00:26 So don't count on that as a finding.

00:31 Laboratory values are unlikely to be of any help to you.

00:34 Even in the setting of a massive bleed from an aortic rupture, the H&H of the hemoglobin and hematocrit may not have changed.

00:43 Now, let's move on to a useful imaging or diagnostic studies.

00:47 Ultrasound is fairly standard.

00:50 Introduces no radiation, and it's easy to follow the patient up.

00:54 However, as with any ultrasound, it is operated dependent in terms of the results that you obtained.

01:02 Here on this image, you see an ultrasound with velocities.

01:05 The velocities are at the peaks and valleys.

01:08 Remember I said earlier, if there is stenotic flow, the velocities tend to be higher.

01:14 In the right upper quadrant of that image, you see an ultrasound with a large cystic lesion.

01:20 How do I know it's cystic or fluid filled? Because it's anechoic, completely dark.

01:25 This is in fact a demonstration of aneurysmic aortic sac.

01:30 Cross sectional imaging is increasingly used for CAT for abdominal aortic aneurysm diagnosis and follow up.

01:38 In this image, we not only see aneurysm but we also see a false lumen.

01:46 You see the actual calcified aneurysm in the center of the image.

01:51 This patient also has fluid around this abdominal aorta.

01:55 Is this patient and impending rupture? Have about angiography? We typically don't think of using angiography as standard diagnostic tool for AAA.

02:06 And the reason is because we're not only interested in the intraluminal filling.

02:10 Remember, if you perform an invasive angiography, the information you're gathering is actually only information on the inside of the lumen.

02:19 For abdominal aortic aneurysms, cross sectional imaging is far more helpful.

02:25 And as a reminder, non-invasive angiography is obtained by multi detector slices are far more accurate these days.

02:34 Here's a neat 3D reconstruction based on cross sectional imaging.

02:38 The AAA is clearly labeled for blue in red.

02:41 Know that proximal and distal to this region, there are some tortuosity but the diameter of those vessels are largely normal.