Suna ERAYBAR, Şule Akköse AYDIN, Meral Leman ÖZKAN, Serhat ATMACA, Yasemin NENNİCİOĞLU

The role of ultrasound imaging at detecting aortic aneurysm in emergency department

Objective: Our study was carried out to investigate the effects of focused ultrasound imaging which is performed by emergency physicians in diagnosis and duration of treatment of abdominal aortic aneurysm. Methods: The patients over 50 years; who applied to Uludağ University Emergency Department with the complaints of abdominal pain, side pain, chest pain, syncope, unexplained hypotension and under suspicion of the abdominal aortic aneurysm, were included in the study. Bedside ultrasound for abdominal aorta was done and diameter measurements of aorta recorded in order to determine the presence of an abdominal aortic aneurysm or to exclude the diagnosis. Results: A total of 133 patients were included in the study. Eight patients were excluded from the study because of inadequate bedside US imaging. The aortic diameter was measured as ≥ 3 cm in the 54 (43.2%) patients. The aortic diameter was found more than 5 cm in 8 (6.4%) patients. After ultrasonographic investigations, aneurysm rupture (n = 5; 4%), aortic dissction (n = 13; 10.4%) and aortic aneurysm (n = 36; 28.8%) were detected. The diagnosis was confirmed with computed tomography in all patients who had aortic pathology. Because of the continuance of clinic suspects in the patients whose aortic diameters were less than 3 cm, their computed tomography images were obtained and their aortic diameters were found within normal limits. Further imaging studies weren’t performed at the remaining 48 (38.4%) patients because different prediagnosis was considered. Emergency ultrasound had a sensitivity of 100% (95% CI: 87-100), a specificity of 91% (95% CI: 90.8-99.8). Conclusions: The diagnosis of abdominal aortic aneurysms is omitted 30% in emergency departments. It has a high morbidity and mortality if the diagnosis is skipped. In the presence of aortic aneurysm suspicion, evaluation of aortic diameter by bedside ultrasound is diagnostic. Bedside ultrasound evaluation by emergency physicians should become routine for using time and investigation numbers properly.

Keywords:

emergency department, abdominal aortic aneurysms, bedside ultrasound,

PDF

___

[1] Graff LG 4th, Robinson D. Abdominal pain and emergency department evaluation. Emerg Med Clin North Am 2001;19:123-36.
[2] Lameris W, Randen A, Dijkdraaf MG, Bossuyt PM, Stoker J, Boermeester MA. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale. BMC Emerg Med 2007;7:9.
[3] Majumper PP, St Jean PL, Ferrell RE, Webster MW, Steed DL. On the inheritance of abdominal aortic aneurysm. Am J Hum Genet 1991;48:164-70.
[4] Bickerstaff LK, Pailero PC, Hollier LH, Melton LJ, Van Peenen HJ, Cherry KJ, et al. Thoracic aortic aneurysms: a population based study. Surgery 1982;92:1103-8.
[5] Soysal M, Denizci U, Bayar R, Keşmer Y, Ulusoy M, Söylemez H, et al. Yaşlı popülasyonda abdominal aort anevrizmasısıklığının ve kardiyovasküler risk faktörleri ile ilişkisinin belirlenmesi. Klinik Gelişim 1996;9:4110-5.
[6] Coady A, Rizza JA, Hammond GL, Mandapati D, Darr U, Kopf GS, et al. What is appropriate size criterion for resection of thoracic aortic aneurysm? J Thorac Cardiovasc Surg 1997;113:476-91.
[7] Pasipoularides A, Murgo JP, Bird JJ, Craig WE. Fluid dynomics of aortic stenosis: mehanisms for the presence of subvalvular pressure gradients. Am J Physiol 1984;246(4 Pt 2):H542-50.
[8] Svensson LG Crawford ES (eds). Cardiovascular and vascular disease of the aorta. 1st edition. Philidelphia: WB Saunders Company; 1997.
[9] Strachan DP. Predictors of death from aortic aneurysm among middle-aged men: the White Hall Study. Br J Surg 1991;78:401-4.
[10] MacSeveney ST, Ellis M, Worrell PC, Greenhalgh RM, Powell JT. Smoking and growth rate of small abdominal aortic aneurysms. Lancet 1994;344:651-2.
[11] Lobato AC, Puceh-Leao P. Predictive factors for rupture of thoracoabdominal aortic aneurysms. J Vasc Surg 1998;27:446-53.
[12] DeSanctis RW, Doroghazi RM, Austen WG, Buckley MJ. Aortic dissection. N Engl J Med 1987;317:1060-67.
[13] Barkin AZ, Rosen CL. Ultrasound detection of abdominal aortic aneurysm. Emerg Med Clin North Am 2004;22:675-8.
[14] American College of Emergency Physicians. Emergency ultrasonography imaging criteria compendum. ACEP Policy Statements. Ann Emerg Med 2009;53:550-70.
[15] Kuhn M, Bonnin RLL, Davey MJ, Rowland JL, Langlois SL. Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate and advantageous. Ann Emerg Med 2000;36:219-23.
[16] Rodin MB, Daviglus ML, Wong GC, Liu K, Garside DB, Greenland P, et al. Middle age cardiovasculer risk faktors and abdominal aortic aneurysm in older age. Hypertension 2003;42:61-8.
[17] Fowkes FG, Housley E, Cawosa FH, Macintyre CC, Ruckley CV, Prescott RJ. Edinburg Artery Study: prevelance of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991;20:384-92.
[18] Vowden P, Wilkinson D, Ausobsky JR, Kester RC. A comparison of three imaging techniques in the assessment of an abdominal aortic aneurysm. J Cardiovasc Surg (Torino) 1989;30:891-6.
[19] Ernst CB. Abdominal aortic aneurysm. N Engl J Med 1993;328:1167-72.
[20] Tayal VS, Graf CD, Gibbs MA. Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years. Acad Emerg Med 2003;10:867-71.
[21] Knaut AL, Kendall JL, Patten R, Ray C. Ultrasonographic measurement of aortic diameter by emergency physicians approximates results obtained by computed tomography. J Emerg Med 2005;28:119-26.
[22] Walker A, Brenchley J, Sloan JP, Lalanda M, Venables H. Ultrasound by emergency physicians to detect abdominal aortic aneurysms: a UK case series. Emerg Med J 2004;21:257-9.
[23] Rose WM III, Ernst CB. Abdominal aortic aneurysm. Comp Ther 1995;21:339-43.