Skip to main content
Top
Published in: International Journal of Emergency Medicine 1/2020

Open Access 01-12-2020 | Ultrasound | Case report

Ruptured abdominal aortic aneurysm identified on point-of-care ultrasound in the emergency department

Authors: Omar Diaz, Wesley Eilbert

Published in: International Journal of Emergency Medicine | Issue 1/2020

Login to get access

Abstract

Background

Ruptured abdominal aortic aneurysm (AAA) is a highly lethal condition which requires rapid identification and treatment to improve the chance of survival. Computed tomography is the diagnostic modality of choice for ruptured AAA though it is time-consuming and often requires movement of the patient out of the emergency department (ED). Point-of-care ultrasound in the ED has excellent sensitivity and specificity for the detection of AAA, though less is known about its use to diagnose AAA rupture. We report a case of ruptured AAA identified on ultrasound performed at the bedside in the ED.

Case presentation

A 77-year-old woman on warfarin with a known AAA presented to our ED with 2 days of epigastric abdominal pain. Point-of-care ultrasound revealed several findings suggestive of rupture of the AAA, which was confirmed on computed tomography. The patient was subsequently taken for emergent operative repair of the AAA and was later discharged from the hospital.

Conclusions

Characteristics suggestive of AAA rupture may be seen on ultrasound. As ED physicians become more familiar with the use of point-of-care ultrasound in the evaluation of abdominal pain, identification of these characteristics may aid in the rapid diagnosis of AAA rupture.
Literature
1.
go back to reference Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101–8.PubMed Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101–8.PubMed
2.
go back to reference Sebesta P, Klika T, Zdrahal P, Kramar J. Ruptured abdominal aortic aneurysm: role of initial delay on survival. J Mal Vasc. 1998;23(5):361–7.PubMed Sebesta P, Klika T, Zdrahal P, Kramar J. Ruptured abdominal aortic aneurysm: role of initial delay on survival. J Mal Vasc. 1998;23(5):361–7.PubMed
3.
go back to reference Lech C, Swaminathan A. Abdominal aortic emergencies. Emerg Med Clin North Am. 2017;35(4):847–67.PubMed Lech C, Swaminathan A. Abdominal aortic emergencies. Emerg Med Clin North Am. 2017;35(4):847–67.PubMed
4.
go back to reference Rubano E, Mehta N, Caputo W, Paladino L, Sinert R. Systematic review: emergency department bedside ultrasonography for diagnosing suspected aortic aneurysm. Acad Emerg Med. 2013;20(2):128–38.PubMed Rubano E, Mehta N, Caputo W, Paladino L, Sinert R. Systematic review: emergency department bedside ultrasonography for diagnosing suspected aortic aneurysm. Acad Emerg Med. 2013;20(2):128–38.PubMed
5.
go back to reference Gollege J. Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nat Rev Cardiol. 2019;16(4):225–42. Gollege J. Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nat Rev Cardiol. 2019;16(4):225–42.
6.
go back to reference Genovese EA, Fonio P, Floridi C, Macchi M, Maccaferri A, Ianora AA, et al. Abdominal vascular emergencies: US and CT assessment. Crit Ultrasound J. 2013;5(Suppl 1):S10.PubMedPubMedCentral Genovese EA, Fonio P, Floridi C, Macchi M, Maccaferri A, Ianora AA, et al. Abdominal vascular emergencies: US and CT assessment. Crit Ultrasound J. 2013;5(Suppl 1):S10.PubMedPubMedCentral
7.
go back to reference Preventative Services Task Force US. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med. 2005;142(3):198–202. Preventative Services Task Force US. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med. 2005;142(3):198–202.
8.
go back to reference Brewster DC, Cronenwett JL, Hallett JW, Johnston KW, Krupski WC, Matsumura JS, et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association of Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003;37(5):1106–17.PubMed Brewster DC, Cronenwett JL, Hallett JW, Johnston KW, Krupski WC, Matsumura JS, et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association of Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003;37(5):1106–17.PubMed
9.
go back to reference Howard DP, Banerjee A, Fairhead JF, Handa A, Silver LE, Rothwell PM, et al. Age-specific incidence, risk factors and outcome of acute abdominal aneurysms in a defined population. Br J Surg. 2015;102(8):907–15.PubMedPubMedCentral Howard DP, Banerjee A, Fairhead JF, Handa A, Silver LE, Rothwell PM, et al. Age-specific incidence, risk factors and outcome of acute abdominal aneurysms in a defined population. Br J Surg. 2015;102(8):907–15.PubMedPubMedCentral
10.
go back to reference Lewiss RE, Egan D, Shreves A. Vascular abdominal emergencies. Emerg Med Clin N Am. 2011;29(2):253–72. Lewiss RE, Egan D, Shreves A. Vascular abdominal emergencies. Emerg Med Clin N Am. 2011;29(2):253–72.
11.
go back to reference Marston WA, Ahlquist R, Johnson G, Meyer AA. Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg. 1992;16(1):17–22.PubMed Marston WA, Ahlquist R, Johnson G, Meyer AA. Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg. 1992;16(1):17–22.PubMed
12.
go back to reference Lederle FA, Parenti CM, Chute EP. Ruptured abdominal aortic aneurysm: the internist as a diagnostician. Am J Med. 1994;96(2):163–7.PubMed Lederle FA, Parenti CM, Chute EP. Ruptured abdominal aortic aneurysm: the internist as a diagnostician. Am J Med. 1994;96(2):163–7.PubMed
13.
go back to reference Plummer D, Clinton J, Matthew B. Emergency department ultrasound improves time to diagnosis and survival in ruptured abdominal aortic aneurysm [Abstract]. Acad Emerg Med. 1998;5(5):417. Plummer D, Clinton J, Matthew B. Emergency department ultrasound improves time to diagnosis and survival in ruptured abdominal aortic aneurysm [Abstract]. Acad Emerg Med. 1998;5(5):417.
14.
go back to reference Catalano O, Siani A. Ruptured abdominal aortic aneurysm. Categorization of sonographic findings and report of 3 new signs. J Ultrasound Med. 2005;24(8):1077–83.PubMed Catalano O, Siani A. Ruptured abdominal aortic aneurysm. Categorization of sonographic findings and report of 3 new signs. J Ultrasound Med. 2005;24(8):1077–83.PubMed
15.
go back to reference Catalano O, Lobianco R, Cusati B. Contrast-enhanced sonography for diagnosis of ruptured abdominal aortic aneurysm. AJR Am J Roentgenol. 2005;184(2):423–7.PubMed Catalano O, Lobianco R, Cusati B. Contrast-enhanced sonography for diagnosis of ruptured abdominal aortic aneurysm. AJR Am J Roentgenol. 2005;184(2):423–7.PubMed
16.
go back to reference Bhatt S, Dogra VS. Catastrophes of abdominal aorta: sonographic evaluation. Ultrasound Clin. 2008;3(1):83–91. Bhatt S, Dogra VS. Catastrophes of abdominal aorta: sonographic evaluation. Ultrasound Clin. 2008;3(1):83–91.
17.
go back to reference Spencer T, Juyia R, Parks R. Case series of patients with ruptured abdominal aortic aneurysm. West J Emerg Med. 2015;16(3):367–71.PubMedPubMedCentral Spencer T, Juyia R, Parks R. Case series of patients with ruptured abdominal aortic aneurysm. West J Emerg Med. 2015;16(3):367–71.PubMedPubMedCentral
Metadata
Title
Ruptured abdominal aortic aneurysm identified on point-of-care ultrasound in the emergency department
Authors
Omar Diaz
Wesley Eilbert
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 1/2020
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-020-00279-9

Other articles of this Issue 1/2020

International Journal of Emergency Medicine 1/2020 Go to the issue