3/30/2016 1 US of the Aorta Renal US Brett Beel MD, RDMS Clinical Instructor, UCSF Fresno Department of Emergency Medicine Clinical Indications • “There is no disease more conducive to clinical humility than the aneurysm of the aorta.” ‐‐William Osler • Prevalence: 2‐5% in population >50yoa, 10% of men >65 with vascular risk factors Clinical Indications • Ruptured AAA has wide clinical presentation • Patients >50 yoa with abdominal pain, flank pain, back pain, testicular pain, constipation • Syncope, hypotension Clinical Indications • <25% ruptured AAA have classic triad of abdominal/back/flank pain, palpable abdominal mass and hypotension • 30‐60% of ruptured AAA are misdiagnosed upon initial presentation • Mortality for ruptured AAA is 80%
Transcript
3/30/2016
1
US of the AortaRenal US
Brett Beel MD, RDMS
Clinical Instructor, UCSF Fresno Department of Emergency Medicine
Clinical Indications
• “There is no disease more conducive to clinical humility than the aneurysm of the aorta.”
‐‐William Osler
• Prevalence: 2‐5% in population >50yoa, 10% of men >65 with vascular risk factors
Clinical Indications
• Ruptured AAA has wide clinical presentation
• Patients >50 yoa with abdominal pain, flank pain, back pain, testicular pain, constipation
• Syncope, hypotension
Clinical Indications
• <25% ruptured AAA have classic triad of abdominal/back/flank pain, palpable abdominal mass and hypotension
• 30‐60% of ruptured AAA are misdiagnosed upon initial presentation
• Mortality for ruptured AAA is 80%
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Ultrasound Nuts/Bolts Sonographic Views
• Transverse Umbilical
• Transverse Subxiphoid
• Longitudinal
• Bifurcation into the iliac arteries
Transverse UmbilicalSubxiphoid
TransverseUmbilical
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Transverse Subxiphoid
Transverse Umbilical
TransverseSubxiphoid
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LongitudinalLongitudinal
Longitudinal
Longitudinal
Bifurcation into Iliacs
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AAA = >3 cm AAA risk of rupture per year
• AAA 3‐4cm: 2%
• AAA 4‐5cm: 1‐5%
• AAA 5‐6 cm: 3‐15%
• AAA 6‐7cm: 10‐20%
• AAA>7cm: 20‐50%
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Caveats
• Adventitia to Adventitia measurements
• Cylinder Tangent Error
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Questions? Renal/Bladder US
Clinical Indications
• Determination of presence/degree of hydronephrosis
