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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. 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

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  1. Emergency Ultrasound of the Aorta Fahad Khan, MD St. Luke’s/Roosevelt Hospital Center Columbia University, New York City April 24, 2009

  2. Case • 70 y/o male presents after witnessed syncopal episode • Upon awakening, patient complained of feeling weak • Patient walked to bathroom and collapsed

  3. 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

  4. Abdominal Ultrasound

  5. Risk Factors for AAA • Male • Atherosclerosis • Smoking • Hypertension • Age

  6. Key Question • Is there an abdominal aortic aneurysm? • Aorta >3cm • Iliac >1.5cm

  7. Indications • Suspected AAA • Pulsatile abdominal mass • Unexplained hypotension/ CV collapse • Elderly • Unexplained back/flank pain • Unexplained hematuria

  8. Abdominal Aorta Anatomy

  9. Minimal Criteria • Transverse • 1) Proximal aorta • 2) Mid aorta • 3) Distal aorta • 4) Iliac bifurcation • Sagittal • 5) Infra-renal

  10. Technique Low Frequency 2-5 MHz

  11. Transverse Views

  12. Proximal Aorta Transverse Splenic Vein Superior Mesenteric Artery Aorta

  13. Proximal Aneurysm

  14. Mid Aorta Transverse Aorta IVC Spine

  15. Aortic Aneurysm

  16. Sagittal Aorta Head Feet

  17. Longitudinal Aneurysm

  18. Distal Aorta and Bifurcation Transverse

  19. Aortic Bifurcation Transverse Right Common Iliac Artery Left Common Iliac Artery Spine

  20. Distal Aneurysm

  21. 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

  22. Useful clinical information can be obtained from emergency ultrasound of the abdominal aorta quickly, and with accuracy as compared to CT.

  23. 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

  24. Questions?

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