Abdominal aortic aneurysm physical examination
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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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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) - ↑ 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.