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What Is the Ideal Imaging Strategy for Diagnosing AAA, Abdominal Aortic Dissection, and Aortic Rupture?

  • Bennett A. MyersEmail author
Chapter

Abstract

The best imaging modality for diagnosis and preoperative management of abdominal aortic pathology is computed tomography angiography (CTA) due to its ability to quickly and accurately map the aneurysm or dissection, identifying location, size, and other involved arterial branches. Ultrasound is the imaging modality of choice for rapid bedside diagnosis of abdominal aortic aneurysm in the emergency setting. It is also used for surveillance of known aneurysmal disease. Diagnostic studies should not delay operative management in patients with strong clinical suspicion for aortic rupture, especially if the patient is hemodynamically unstable and has a previous diagnosis of aortic aneurysm and/or dissection.

Keywords

Aortic dissection Abdominal aortic aneurysm Aortic rupture Computed tomography Ultrasound Magnetic resonance imaging Radiography Angiography 

References

  1. 1.
    Reardon RF, Clinton ME, Madore F, Cook TP. Abdominal aortic aneurysm. In: Ma OJ, Mateer JR, Reardon RF, Joing SA, editors. Ma & Mateer’s emergency ultrasound. 3rd ed. New York (NY): McGraw Hill; 2014. p. 225–45.Google Scholar
  2. 2.
    Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician. 2015;91(8):538–43.PubMedGoogle Scholar
  3. 3.
    Silverstein MD, Pitts SR, Chaikof EL, Ballard DJ. Abdominal aortic aneurysm (AAA): cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. BAYLOR UNIV MED CENT PROC 2005. 2005;18(4):345–67.CrossRefGoogle Scholar
  4. 4.
    Alamoudi AO, Haque S, Srinivasan S, Mital DP, (2015) Diagnostic efficacy value in terms of sensitivity and specificity of imaging modalities in detecting the abdominal aortic aneurysm: a systematic review. International Journal of Medical Engineering and Informatics 7 (1):15.CrossRefGoogle Scholar
  5. 5.
    Fojtik JP, Costantino TG, Dean AJ. The diagnosis of aortic dissection by emergency medicine ultrasound. J Emerg Med. 2007;32(2):191–6.CrossRefGoogle Scholar
  6. 6.
    Baliga RR, Nienaber CA, Bossone E, Oh JK, Isselbacher EM, Sechtem U, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging. 2014;7(4):406–24.CrossRefGoogle Scholar
  7. 7.
    Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey J, Donald E, et al. Practice guideline: full text: 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010;55:e27–e129.CrossRefGoogle Scholar
  8. 8.
    Reis SP, Majdalany BS, AbuRahma AF, Collins JD, Francois CJ, Ganguli S, et al. Appropriate use criteria: ACR appropriateness criteria® pulsatile abdominal mass suspected abdominal aortic aneurysm. J Am Coll Radiol. 2017;14(5S):S258–65.CrossRefGoogle Scholar
  9. 9.
    Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al. SVS practice guidelines: SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg. 2009;50:880–96.CrossRefGoogle Scholar
  10. 10.
    Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101–8.CrossRefGoogle Scholar
  11. 11.
    Guirguis-Blake J, Beil TL, Sun X, Senger CA, Whitlock EP. Primary care screening for abdominal aortic aneurysm: a systematic evidence review for the U.S. Preventive Services Task Force. Jan 2014.Google Scholar
  12. 12.
    Hong H, Yang Y, Liu B, Cai W. Imaging of abdominal aortic aneurysm: the present and the future. Curr Vasc Pharmacol. 2010;8(6):808–19.CrossRefGoogle Scholar
  13. 13.
    Rubano E, Mehta N, Caputo W, Paladino L, Sinert R, Carpenter C. Systematic review: emergency department bedside ultrasonography for diagnosing suspected abdominal aortic aneurysm. Acad Emerg Med. 2013;20(2):128–38.CrossRefGoogle Scholar
  14. 14.
    Singh M, Koyfman A, Martinez JP. Abdominal vascular catastrophes. Emerg Med Clin North Am. 2016;34:327–39.CrossRefGoogle Scholar
  15. 15.
    Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA practice guideline: ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, AAVS/SVS when guideline initiated, now merged into SVSSociety for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease). Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47:1239–312.CrossRefGoogle Scholar
  16. 16.
    Thrumurthy SG, Karthikesalingam A, Patterson BO, Holt PJE, Thompson MM. The diagnosis and management of aortic dissection. BMJ (Overseas & Retired Doctors Edition). 2012;344(7839):37–42.Google Scholar
  17. 17.
    Williams J, Heiner JD, Perreault MD, McArthur TJ. Aortic dissection diagnosed by ultrasound. West J Emerg Med. 2010;11(1):98–9. 2010(1):98.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA. Acute aortic dissection and intramural hematoma: a systematic review. JAMA. 2016;316(7):754–63.CrossRefGoogle Scholar
  19. 19.
    Paajanen H, Lahti P, Nordback I. Sensitivity of transabdominal ultrasonography in detection of intraperitoneal fluid in humans. Eur Radiol. 1999;9(7):1423–5.CrossRefGoogle Scholar
  20. 20.
    Vu K, Kaitoukov Y, Morin-Roy F, Kauffmann C, Giroux M, Thérasse E, et al. Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms. Insights Imaging. 2014;5(3):281–93.CrossRefGoogle Scholar
  21. 21.
    Rakita D, Newatia A, Hines JJ, Siegel DN, Friedman B. Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms. Radiographics. 2007;27(2):497–507.CrossRefGoogle Scholar
  22. 22.
    Kumar Y, Hooda K, Li S, Goyal P, Gupta N, Adeb M. Abdominal aortic aneurysm: pictorial review of common appearances and complications. Ann Transl Med. 2017;5(12):256.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreUSA

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