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Question 1 of 2
1. Question
Clinical Description:
A 72 yr old lady with a history of hypertension collapses at home with abdominal pain and presents with severe pain and mild hypotension.
Is there an abdominal aortic aneurysm?
Correct
There is a 6cm AAA. This was seen to pulsate on real time imaging. Measurements are taken outer wall to outer wall and the largest diameter is the diagnostic measurement. Note that the depth has been adjusted in the second (more distal) image so although the diameter appears larger on the screen, the measurement is taken from the first image.
In addition the last two images show a hetrogenous mass in the right abdomen suggestive of a large haematoma.
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Question 2 of 2
2. Question
Clinical Description:
A 72 yr old lady with a history of hypertension collapses at home with abdominal pain and presents with severe pain and mild hypotension.
What is the management of this patient?
Correct
Once an abdominal aortic aneurysm is detected in the clinical setting of ? ruptured AAA then further ultrasound imaging does not usually alter management (ie the detection of the retroperitoneal haematoma suggesting rupture may be interesting but does not alter management). It is extremely rare for colour Doppler imaging to show an active bleed in a ruptured AAA.
If the patient is very unstable then they may need open repair, but this is now uncommon, and rapid CT is usually performed to allow emergency endovascular repair.
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