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. Ramyar Ghandriz MD[3]

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:[1]

Skin

  • Skin examination of patients with abdominal aortic aneurysm is usually normal.

HEENT

  • HEENT examination of patients with abdominal aortic aneurysm is usually normal.

Neck

  • Neck examination of patients with abdominal aortic aneurysm is usually normal.

Lungs

  • Pulmonary examination of patients with abdominal aortic aneurysm is usually normal.

Heart

  • Cardiovascular examination of patients with abdominal aortic aneurysm is usually normal.[2]
  • Tachycardia may be present in ruptured aneurysm.
  • Radiated bruit may be present in auscultation.

Abdomen

Inspection

Flank ecchymosis (Grey Turner sign) may be present in cases of ruptured aneurysms due to retroperitoneal hemorrhage.[3]

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 [4].

Management of Patients With Peripheral Artery Disease

Symptomatic Aortic or Iliac Aneurysms

  • 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.[5]
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. Moll, F.L.; Powell, J.T.; Fraedrich, G.; Verzini, F.; Haulon, S.; Waltham, M.; van Herwaarden, J.A.; Holt, P.J.E.; van Keulen, J.W.; Rantner, B.; Schlösser, F.J.V.; Setacci, F.; Ricco, J.-B. (2011). "Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery". European Journal of Vascular and Endovascular Surgery. 41: S1–S58. doi:10.1016/j.ejvs.2010.09.011. ISSN 1078-5884.
  2. Fink, Howard A.; Lederle, Frank A.; Roth, Craig S.; Bowles, Carolyn A.; Nelson, David B.; Haas, Michele A. (2000). "The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm". Archives of Internal Medicine. 160 (6): 833. doi:10.1001/archinte.160.6.833. ISSN 0003-9926.
  3. Fink, Howard A.; Lederle, Frank A.; Roth, Craig S.; Bowles, Carolyn A.; Nelson, David B.; Haas, Michele A. (2000). "The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm". Archives of Internal Medicine. 160 (6): 833. doi:10.1001/archinte.160.6.833. ISSN 0003-9926.
  4. 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. doi:10.1016/j.jvs.2009.07.002. PMID 19786250. Unknown parameter |month= ignored (help)
  5. 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. doi:10.1016/j.jacc.2013.01.004. PMC 4492473. PMID 23473760.

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