Abdominal Aortic Aneurysm: Examination and Diagnosis

by Kevin Pei, MD

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    00:01 What might be the patient presenting with if in the emergency room the patient may come in with abdominal radiation radiating to the back pain? This is particularly alarming.

    00:14 In fact, if you're presented with the clinical scenario that shows a patient complaining of abdominal pain that searing in nature and it's radiating to the back.

    00:23 You shouldn't think of pancreatitis as your number one diagnosis the exam may be trying to lead you to an impending rupture.

    00:30 Now the vast majority of the patients are however asymptomatic.

    00:37 Let me pose a question to you.

    00:38 What is the classic presentation for a patient with impending AAA rupture? I'll give you a second to think about this.

    00:49 That's right severe abdominal pain radiating to the back and potentially a pulsatile mass.

    00:54 Now with the increase of obesity.

    00:58 Our patients are more and more difficult to diagnose in terms of pulsatile masses.

    01:02 So don't count on that as a finding.

    01:07 That would Tori values are unlikely to be of any help to you.

    01:10 Even in the setting of a massive bleed of an aortic rupture.

    01:13 Each in each of a haematic hemoglobin and hematocrit may not have changed.

    01:19 Now let's move on to a useful imaging or diagnostic studies ultrasound is fairly standard introduces no radiation and it's easy to follow the patient up.

    01:30 However, as with any ultrasound it is operated attempt dependent in terms of the results that you obtained.

    01:38 Here on this image.

    01:39 You see an ultrasound with velocities.

    01:42 The velocities are at the Peaks and valleys.

    01:44 Remember I said earlier, if there is stenotic flow.

    01:48 The velocities tend to be higher in the right upper quadrant of that image.

    01:53 You see an ultrasound with a large cystic lesion.

    01:56 How do I know it's cystic or fluid-filled because it's anechoic completely dark.

    02:01 This is in fact a demonstration of an aneuresmic aoctic sac.

    02:06 Cross-sectional imaging is increasingly used for cat a for abdominal aortic aneurysm diagnosis and follow-up.

    02:15 In this image, we not only see aneurysm but we also see a false lumen.

    02:22 You see the actual calcified aneurysm in the center of the image.

    02:28 This patient also has fluid around this abdominal aorta Is this patient and impending rupture? How about angiography? We typically don't think of using angiography as standard diagnostic tool for Triple A's and the reason is because we're not only interested in the Remember if you perform an invasive angiography the information your gatherings actually only information on the inside of the Lumen for a abdominal aortic aneurysms cross-sectional Imaging is far more helpful and as a reminder non invasive angiographies obtained by multi-slight multi detector slices or far more accurate these days.

    03:10 Here's a neat 3D reconstruction based on cross-sectional imaging.

    03:14 The AAA is clearly labeled for you in red note that proximal and distal to this region.

    03:21 There's some tortuosity, but the diameter of those vessels are largely normal.

    About the Lecture

    The lecture Abdominal Aortic Aneurysm: Examination and Diagnosis by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. Ruptured abdominal aortic aneurysm
    2. Ruptured aortic root aneurysm
    3. Thoracoabdominal aortic aneurysm
    4. Aortic root aneurysm
    5. Unruptured abdominal aortic aneurysm
    1. Plain radiographs
    2. Ultrasonography
    3. CT scan
    4. Angiography
    5. MRI

    Author of lecture Abdominal Aortic Aneurysm: Examination and Diagnosis

     Kevin Pei, MD

    Kevin Pei, MD

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