Case: Size not all that matters

57 year old female smoker presents to the quick track area with chronic back pain, progressive for two years, especially since helping a friend move 6 months prior. Abdominal, back and neurologic exams unremarkable. "Teaching" US performed.  

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Next Step?

What to Know

  1. List indications, contraindications, and limitations of CUS for the evaluation of abdominal aortic aneurysms (AAA) and other aortic emergencies.
  2. Perform the CUS protocols required.
  3. Identify clinically relevant sonographic anatomy including the aorta with major branches, inferior vena cava, and vertebral bodies.
  4. Recognize the relevant focused findings and pitfalls when evaluating for AAA and Aortic dissection.
  5. Describe different types of aneurysms.
  6. 57 year old female present to the quick track area with chronic back pain, progressive times two years, worse for 6 months after helping a friend move. Abdominal, back and neurologic exams unremarkable. Teaching US performed. accurate measurement of an AAA.

Introduction to Bedside Ultrasound
Free iBook download Vol 1 and Vol 2
Chapter 3: Aorta
Self Assessment Quiz

ACEP US Section Resources

SAEM Academy of EUS Resources

Emergency Ultrasound by Geoff Hayden

Aorta Lecture

Key Articles
  1. ACEP Emergency Ultrasound Guidelines 2016
  2. Tayal VS, Graf CD, Gibbs M a. Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years. Acad Emerg Med. 2003;10(8):867–71.
  3. Hoffmann B, Um P, Bessman ES, Ding R, Kelen GD, McCarthy ML. Routine screening for asymptomatic abdominal aortic aneurysm in high-risk patients is not recommended in emergency departments that are frequently crowded. Acad Emerg Med Off J Soc Acad Emerg Med. 2009;16(11):1242–1250.

Case Follow Up

Changing modes, you confirm that the presence of clot in the distal aorta through the femoral arteries. 

The patient was admitted. CUS was confirmed by inpatient angiography followed by vascular bypass graft placement.