Approximately 6 cm abdominal aortic aneurysm with intramural thrombus.
Frances Russell, MD, RDMS
Assistant Professor of Emergency Medicine Division Chief, Ultrasound Fellowship Director, Ultrasound
The clip above is from a patient who presented with abdominal pain and syncope. His vitals were notable for tachycardia and hypotension. The image demonstrates a very large abdominal aortic aneurysm with anterior free fluid suggestive of rupture. The patient was taken emergently to the operating room for endograft repair and did well.
Jason Tanguay, DO
Abdominal Aortic Dissection (Transverse)
Aortic dissection carries an incredibly high mortality that increases 1%/hour. POCUS can be used as a rule-in test to quickly identify this life threatening diagnosis. If a dissection is not seen on POCUS, CT angiography should still be performed because the sensitivity of POCUS is not as high as for other indications.
The spine can be used as a landmark - the echogenic stripe with shadowing in the midline. The aorta is the large vessel anterior and slightly to the right of the spine. In this image an intimal flap can be seen in the anterior third of the aorta consistent with an aortic dissection. The IVC cannot be clearly visualized in this image but would normally be left, less pulsatile, with a less echogenic vessel wall. Non-visualization of the IVC is most often due to bowel gas or compression of the abdomen with the probe.
Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al.
Pulsating Aortic Aneurysm
You may think this a dissection but it's actually an aortic aneurysm filled with thrombus, "with holes" making it a very "happy flappy." CT Confirmed.
Dr. Vincent Rietveld - Amsterdam, The Netherlands
Abdominal Aortic Aneurysm
AAA is defined as a localized balloon-like dilatation of the abdominal aorta greater than 3cm. Risk factors include male sex, increased age, and tobacco use. AAAs should be closely monitored for changes in size. Due to the risk of rupture, elective surgery is recommended when the dilatation is greater than 5-5.5cm, or it is growing in size by greater than 1cm/year. The classic triad of a ruptured AAA include pulsatile abdominal mass, hypotension and pain.
This AAA has an intramural thrombus. Some studies have claimed that POCUS has a ~100% sensitive for increased diameter. 3cm from outer wall to outer wall defines an aneurysm. Slow, graded compression is key to move the bowel out of the way in any abdominal study.