Problems in CT Diagnosis of Ruptured Abdominal Aortic Aneurysms

Me, Gale; Wc, Johnson; Gerzof, SG; Ah, Robbins

doi:10.1097/00004728-198607000-00018

Cited by 15 publications

(5 citation statements)

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“…Blebs have been observed on CT scanning by other authors, but their significance has been ascribed to unusual aneurysm shape or has remained unexplained? , 29 Attentuation of the aneurysmal wall because of a bleb was detected by CT scanning in four of the five patients. The failure to detect a bleb by CT scanning in the other patient studied can possibly be explained by the 2 cm distance between the 1 cm thick transverse section images routinely used in the evaluation of patients with aneurysms.…”

Section: Discussionmentioning

confidence: 89%

Aortic blebs: Possible site of aneurysm rupture

Hunter¹,

Leong²,

Yu³

et al. 1989

Journal of Vascular Surgery

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Although the growth and rupture of abdominal aortic aneurysms are commonly explained by Laplace's law, the final events that precede aneurysm rupture are not fully understood. Local excrescences within the wall of abdominal aortic aneurysms were observed in four of five patients studied with preoperative CT scanning, and were removed from six patients at the time of surgery. These protrusions were filled with thrombus, and on histologic examination marked attenuation of the aortic wall, focal loss of elastic fibers, and inflammatory cell infiltrates of lymphocytes, plasma cells, and occasional multinucleate giant cells were seen. The presence of these blebs and their microscopic characteristics suggest their potential as a mechanism for rupture and recognition of this deformity by use of abdominal CT scanning may indicate the necessity for prompt surgical intervention. Further careful clinicopathologic correlation is required to clearly establish these localized defects in the aneurysm wall as a cause for rupture.

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Section: Discussionmentioning

confidence: 89%

Aortic blebs: Possible site of aneurysm rupture

Hunter¹,

Leong²,

Yu³

et al. 1989

Journal of Vascular Surgery

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“…Following duplicate removal, we screened 4,735 titles and abstracts, 49 of which underwent full‐text review. We included a total of 20 studies, with a combined 2,077 patients in the meta‐analysis 26–45 …”

Section: Resultsmentioning

confidence: 99%

“…We included a total of 20 studies, with a combined 2,077 patients in the meta-analysis. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]…”

Section: Re Sults Searchresultsmentioning

confidence: 99%

“…A total of 11 studies provided data on the accuracy of presenting symptoms and physical examination signs. 26,28,32,34,35,[37][38][39][40][41]43 Pooled sensitivity for each symptom is demonstrated in Table 2, and relevant forest plots are shown in Figures S3-S5. GRADE evidence profiles are included in Table S3.…”

Section: Presenting Symptoms and Physical Examinationmentioning

confidence: 99%

“…A total of seven studies (360 patients) evaluated the accuracy of CTA for diagnosis of rAAA. 27,29,34,36,42,44,45 The forest plot and pooled estimates are depicted in Figure 2A and 2B. The HSROC curve is displayed in Figure 2C.…”

Section: Computed Tomography With Angiographymentioning

confidence: 99%

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Accuracy of presenting symptoms, physical examination, and imaging for diagnosis of ruptured abdominal aortic aneurysm: Systematic review and meta‐analysis

Fernando

Tran

Cheng

et al. 2022

Academic Emergency Medicine

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Objectives: Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition, and rapid diagnosis is necessary to facilitate early surgical intervention. We sought to evaluate the accuracy of presenting symptoms, physical examination signs, computed tomography with angiography (CTA), and point-of-care ultrasound (PoCUS) for diagnosis of rAAA.Methods:We searched six databases from inception through April 2021. We included studies investigating the accuracy of any of the above tests for diagnosis of rAAA. The primary reference standard used in all studies was intraoperative diagnosis or death from rAAA. Because PoCUS cannot detect rupture, we secondarily assessed its accuracy for the diagnosis of AAA, using the reference standard of intraoperative or CTA diagnosis. We used GRADE to assess certainty in estimates. Results:We included 20 studies (2,077 patients), with 11 of these evaluating signs and symptoms, seven evaluating CTA, and five evaluating PoCUS. Pooled sensitivities of abdominal pain, back pain, and syncope for rAAA were 61.7%, 53.6%, and 27.8%, | 487 FERNANDO et al.

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Computed Tomography of Abdominal Aortic Aneurysm

Pillari

Chang²,

Zito³

et al. 1988

Arch Surg

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Patients who present to the emergency department (ED) with aortic emergencies can be some of the highest acuity patients that we manage. Ultrasonography performed at the bedside is traditionally considered to be a screening test that is especially useful in the unstable patient. Computed tomography (CT) with angiography is the imaging modality of choice to confirm the diagnosis and plan the management of abdominal aortic aneurysm (AAA), as an ultrasound is generally thought not to provide the clinician with sufficient anatomical information. We present a case of a patient with an abdominal aortic aneurysm where evidence obtained from the ultrasound provided more useful information regarding aneurysm structure and stability than did CT.

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Problems in CT Diagnosis of Ruptured Abdominal Aortic Aneurysms

Cited by 15 publications

References 0 publications

Aortic blebs: Possible site of aneurysm rupture

Aortic blebs: Possible site of aneurysm rupture

Accuracy of presenting symptoms, physical examination, and imaging for diagnosis of ruptured abdominal aortic aneurysm: Systematic review and meta‐analysis

Computed Tomography of Abdominal Aortic Aneurysm

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