00:01
Let me pose a question to you.
00:02
What is the classic presentation
for a patient
with impending AAA rupture?
I'll give you a second
to think about this.
00:12
That's right, severe abdominal pain
radiating to the back,
and potentially a pulsatile mass.
00:18
Now, with the increase of obesity,
our patients are more and more
difficult to diagnose
in terms of pulsatile masses.
00:26
So don't count on that
as a finding.
00:31
Laboratory values are unlikely
to be of any help to you.
00:34
Even in the setting
of a massive bleed
from an aortic rupture,
the H&H of the
hemoglobin and hematocrit
may not have changed.
00:43
Now, let's move on to a useful
imaging or diagnostic studies.
00:47
Ultrasound is fairly standard.
00:50
Introduces no radiation, and it's
easy to follow the patient up.
00:54
However, as with any ultrasound,
it is operated dependent
in terms of the results
that you obtained.
01:02
Here on this image, you see
an ultrasound with velocities.
01:05
The velocities are at
the peaks and valleys.
01:08
Remember I said earlier,
if there is stenotic flow,
the velocities tend to be higher.
01:14
In the right upper quadrant
of that image,
you see an ultrasound with
a large cystic lesion.
01:20
How do I know
it's cystic or fluid filled?
Because it's anechoic,
completely dark.
01:25
This is in fact a demonstration
of aneurysmic aortic sac.
01:30
Cross sectional imaging
is increasingly used for CAT
for abdominal aortic aneurysm
diagnosis and follow up.
01:38
In this image,
we not only see aneurysm
but we also see a false lumen.
01:46
You see the actual calcified
aneurysm in the center of the image.
01:51
This patient also has fluid
around this abdominal aorta.
01:55
Is this patient and
impending rupture?
Have about angiography?
We typically don't think
of using angiography
as standard diagnostic tool
for AAA.
02:06
And the reason is because
we're not only interested
in the intraluminal filling.
02:10
Remember, if you perform
an invasive angiography,
the information you're gathering
is actually only information
on the inside of the lumen.
02:19
For abdominal aortic aneurysms,
cross sectional imaging
is far more helpful.
02:25
And as a reminder,
non-invasive angiography is
obtained by multi detector slices
are far more accurate these days.
02:34
Here's a neat 3D reconstruction
based on cross sectional imaging.
02:38
The AAA is clearly
labeled for blue in red.
02:41
Know that proximal and distal
to this region,
there are some tortuosity
but the diameter of those vessels
are largely normal.