Abdominal aortic aneurysm physical examination

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Abdominal Aortic Aneurysm Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Hardik Patel, M.D.

Overview

A physical examination has low sensitivity in the detection of small abdominal aortic aneurysms (29-61% for abdominal aortic aneurysms 3.0-3.9 cm in diameter), but has a sensitivity of 76-82% in the detection those abdominal aortic aneurysms that are 5.0 cm or larger that may warrant repair. It is easier to detect a pulsatile mass in thin patients and those who do not have tense abdomens. Contrary to popular belief, gentle palpation of abdominal aortic aneurysms is safe and does not precipitate a rupture.

Physical Examination

General

Vital Signs

The following may or may not be present:

Abdomen

Inspection

Flank ecchymosis (Grey Turner sign) may be present in cases of ruptured aneurysms due to retroperitoneal hemorrhage.

Palpation

A pulsating or non-pulsating abdominal mass may be palpable.

Auscultation

The presence of an abdominal bruit is nonspecific for a nonruptured aneurysm and can be present in cases of visceral or renal arterial stenosis [1].

Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[2]

Symptomatic Aortic or Iliac Aneurysms

Class I
"1.In patients with the clinical triad of abdominal and/or back pain, a pulsatile abdominal mass, and hypotension, immediate surgical evaluation is indicated.(Level of Evidence: B)"
"2.In patients with symptomatic aortic aneurysms, repair is indicated regardless of diameter. (Level of Evidence: C) "

References

  1. Chaikof, EL.; Brewster, DC.; Dalman, RL.; Makaroun, MS.; Illig, KA.; Sicard, GA.; Timaran, CH.; Upchurch, GR.; Veith, FJ. (2009). "The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines.". J Vasc Surg. 50 (4 Suppl): S2–49. PMID 19786250. doi:10.1016/j.jvs.2009.07.002.  Unknown parameter |month= ignored (help)
  2. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.". J Am Coll Cardiol. 61 (14): 1555–70. PMC 4492473Freely accessible. PMID 23473760. doi:10.1016/j.jacc.2013.01.004. 


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