Abdominal Aortic Aneurysm: Examination and Diagnosis

by Kevin Pei, MD

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    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.

    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. MRI

    Author of lecture Abdominal Aortic Aneurysm: Examination and Diagnosis

     Kevin Pei, MD

    Kevin Pei, MD

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