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Emergency Ultrasound of the Aorta. Fahad Khan, MD St. Luke’s/Roosevelt Hospital Center Columbia University, New York City April 24, 2009. Case. 70 y/o male presents after witnessed syncopal episode Upon awakening, patient complained of feeling weak Patient walked to bathroom and collapsed.

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emergency ultrasound of the aorta

Emergency Ultrasound of the Aorta

Fahad Khan, MD

St. Luke’s/Roosevelt Hospital Center

Columbia University, New York City

April 24, 2009

slide3
Case
  • 70 y/o male presents after witnessed syncopal episode
  • Upon awakening, patient complained of feeling weak
  • Patient walked to bathroom and collapsed
slide4
Case
  • Afebrile, 110, 95/50, 18, 98% RA
  • Appears pale, diaphoretic
  • Tachycardic, S1S2
  • CTAB
  • Abd: soft, periumbilical tenderness, no rebound, no guarding
  • Otherwise unremarkable exam
risk factors for aaa
Risk Factors for AAA
  • Male
  • Atherosclerosis
  • Smoking
  • Hypertension
  • Age
key question
Key Question
  • Is there an abdominal aortic aneurysm?
    • Aorta >3cm
    • Iliac >1.5cm
indications
Indications
  • Suspected AAA
  • Pulsatile abdominal mass
  • Unexplained hypotension/ CV collapse
  • Elderly
    • Unexplained back/flank pain
    • Unexplained hematuria
minimal criteria
Minimal Criteria
  • Transverse
    • 1) Proximal aorta
    • 2) Mid aorta
    • 3) Distal aorta
    • 4) Iliac bifurcation
  • Sagittal
    • 5) Infra-renal
technique
Technique

Low Frequency 2-5 MHz

proximal aorta transverse
Proximal Aorta Transverse

Splenic Vein

Superior Mesenteric

Artery

Aorta

aortic bifurcation transverse
Aortic Bifurcation Transverse

Right Common

Iliac Artery

Left Common

Iliac Artery

Spine

pitfalls
Pitfalls
  • Only true contraindication – delaying immediate surgical intervention
  • Over-reliance – finding a AAA, does not mean it has ruptured
  • Error in imaging – parasagittal plane
  • Patient factors – body habitus, bowel gas
slide24
Useful clinical information can be obtained from emergency ultrasound of the abdominal aorta quickly, and with accuracy as compared to CT.
slide25
Emergency ultrasound of the abdominal aorta is very sensitive and specific
  • Can guide and expedite urgent vascular consultation
  • AAA can be effectively excluded by bedside emergency ultrasound regardless of patient’s disposition