Introduction

With the possible exception of pericardial tamponade, there is no other condition in which the special capabilities of bedside sonography are of such striking benefit (1, 2). Emergency bedside ultrasonography enables the emergency physician to confirm a high-risk diagnosis – decreasing the time needed to mobilize resources – or even transfer the patient to a referral center if necessary. This one exam will save lives if incorporated into the regular practice of emergency physicians and other critical care physicians involved in the evaluation of acutely ill patients (1).

Part of the reason for this is because abdominal aortic aneurysms (AAAs) can present with such varied symptoms. Patients can have back pain, flank pain that sounds like ureteral colic, syncope, abdominal pain, gastrointestinal bleeding, or any variety of these. Because of this and because of the ease of a screening abdominal aortic ultrasound, it is recommended that all patients with the aforementioned presenting symptoms and risk factors for AAA undergo an ultrasound screening exam. This is particularly true if a patient with flank pain is found to have unilateral hydronephrosis. An expanding abdominal aneurysm can compress the ureter so hydronephrosis results. It is far better to do extra screening exams in at-risk patients with flank pain, than to miss this life-threatening diagnosis.

Focused questions for aortic ultrasound

The focused questions for aorta ultrasound are as follows:

1. Is the abdominal aorta >3 cm in diameter?

2. Are the ileac arteries >1.5 cm in diameter?