Emergency Emergency Ultrasound of the Ultrasound of the
AortaAortaFahad Khan, MDFahad Khan, MD
St. Luke’s/Roosevelt Hospital CenterSt. Luke’s/Roosevelt Hospital CenterColumbia University, New York CityColumbia University, New York City
April 24, 2009April 24, 2009
CaseCase
70 y/o male presents after 70 y/o male presents after witnessed syncopal episodewitnessed syncopal episode
Upon awakening, patient Upon awakening, patient complained of feeling weakcomplained of feeling weak
Patient walked to bathroom and Patient walked to bathroom and collapsedcollapsed
CaseCase
Afebrile, 110, 95/50, 18, 98% RAAfebrile, 110, 95/50, 18, 98% RA Appears pale, diaphoreticAppears pale, diaphoretic Tachycardic, S1S2Tachycardic, S1S2 CTABCTAB Abd: soft, periumbilical tenderness, no Abd: soft, periumbilical tenderness, no
rebound, no guardingrebound, no guarding Otherwise unremarkable examOtherwise unremarkable exam
Risk Factors for AAARisk Factors for AAA
MaleMale AtherosclerosisAtherosclerosis SmokingSmoking HypertensionHypertension AgeAge
Key QuestionKey Question
Is there an abdominal aortic aneurysm?Is there an abdominal aortic aneurysm? Aorta >3cmAorta >3cm Iliac >1.5cm Iliac >1.5cm
IndicationsIndications
Suspected AAASuspected AAA Pulsatile abdominal massPulsatile abdominal mass Unexplained hypotension/ CV Unexplained hypotension/ CV
collapsecollapse ElderlyElderly
Unexplained back/flank painUnexplained back/flank pain Unexplained hematuriaUnexplained hematuria
Minimal CriteriaMinimal Criteria
TransverseTransverse 1) Proximal aorta1) Proximal aorta 2) Mid aorta2) Mid aorta 3) Distal aorta3) Distal aorta 4) Iliac bifurcation4) Iliac bifurcation
SagittalSagittal 5) Infra-renal5) Infra-renal
Aortic Bifurcation TransverseAortic Bifurcation Transverse
Right Common Iliac Artery
Left Common Iliac Artery
Spine
PitfallsPitfalls
Only true contraindication – delaying Only true contraindication – delaying immediate surgical interventionimmediate surgical intervention
Over-reliance – finding a AAA, does Over-reliance – finding a AAA, does not mean it has rupturednot mean it has ruptured
Error in imaging – parasagittal planeError in imaging – parasagittal plane Patient factors – body habitus, bowel Patient factors – body habitus, bowel
gasgas
Useful clinical information can be Useful clinical information can be obtained from emergency ultrasound of obtained from emergency ultrasound of the abdominal aorta quickly, and with the abdominal aorta quickly, and with accuracy as compared to CT.accuracy as compared to CT.
Emergency ultrasound of the abdominal aorta Emergency ultrasound of the abdominal aorta is very sensitive and specificis very sensitive and specific
Can guide and expedite urgent vascular Can guide and expedite urgent vascular consultation consultation
AAA can be effectively excluded by bedside AAA can be effectively excluded by bedside emergency ultrasound regardless of patient’s emergency ultrasound regardless of patient’s dispositiondisposition