5 - AA US

Question 1

AAA screening?

Answer 1

50+ y/o
Pain in 
- abdomen
- back
- groin
Dizziness
Syncope
Unexplained HOTN
Cardiac arrest

Question 2

How common is AAA?

Answer 2

2-5% over 50y/o

10% men >65y/o w risk factors

Question 3

Risk of AAA rupture?

Answer 3

Related to size
- goes up a lot >5cm

So over 5.5 we repair

Question 4

Main indication of POC aortic US exam?

Answer 4

Rapidly ID pts w AAA

Question 5

Indications for bedside Aortic US exam?

Answer 5

Pts >50y/o +

• classic presentation of AAA
• pain consistent w ruptured AAA
• unexplained HOTN, dizziness, syncope
• cardiac arrest

Question 6

USPSTF recommendation for AAA screening?

Answer 6

men 65-75 w h/o of tobacco

Question 7

Classic presentation of ruptured AAA

Answer 7

Triad (Only seen <25%)

• abd/back flank pain
• palpable abd mass
• HOTN

Question 8

How consistent are the ss of the “classic” triad?

Answer 8

All <25%
Pain >80%
Abd mass - not reliable
HOTN - not reliable

Question 9

If the AAA ruptures into the retroperitoneum?

Answer 9

Leads to Transient tamponade effect

Question 10

Anatomic considerations of AA?

Answer 10

Entirely retroperitoneal structure
10-20cm in length
Normal diameter <3cm

Question 11

MCC of inability to view AA?

Answer 11

Bowel gas

Question 12

Pt position for AA exam?

Answer 12

Supine

- L/R decubital position (if gassy)

Question 13

Transverse view of AA?

Answer 13

Scan aorta from proximal to distal

• proximal (celiac trunk or SMA)
• distal (aorta bifurcation into iliac areteries)

Question 14

3 measurements of aorta?

Answer 14

AP diameter
Outer wall to outer wall
- proximal (celiac trunk/SMA)
- middle (betweenxyphoid and bifurcation)
- distal (above bifurcation into iliac)(T5)

Question 15

Pics

Answer 15

14-31

Question 16

AAA US summary?

Answer 16

Scan entire length w curvilinear probe from proximal-distal in both:

• transverase view (probe to R)
• sagittal view (probe to Head)

Record 3 aorta measuriments in transverse view at proximal, mid and distal

• outer wall to outer wall
• normal <3cm

Question 17

Artifact when scanning AAA?

Answer 17

Bowel gas (dirty shadow)
 - press harder

Umbilicus (clean shadow)
- fill w gel

Question 18

Two satellites decided to get married

Answer 18

The wedding wasnt much but the reception was incredible