You should conduct an ultrasound of the aorta whenever you suspect abdominal aortic aneurysm (AAA) or aortic dissection.
- The US preventative task force recommends a one-time screening for AAA in male patients between the ages of 65-75 who have ever smoked.
- Male sex and advanced age (≥ 65) are considered risk factors for both AAA and aortic dissection. However, keep in mind that patients with congenital risk factors will commonly present before age 40 (Lederle, Howard).
Below is a table to keep in mind when considering Abdominal Aortic Aneurysm (AAA) or Aortic Dissection:
| Abdominal Aortic Aneurysm (AAA) | Aortic Dissection | |
| Pain quality | Constant, intense abdominal, back, pelvic, or flank pain that may radiate to buttocks, groin, or thighs | Acute-onset, severe chest or back pain with ripping/tearing/sharp or stabbing quality |
| Risk factors | Smoking Hypertension Hypercholesterolemia Atherosclerosis & coronary artery disease | Acquired: Hypertension Smoking Third Trimester Pregnancy Amphetamines, cocaine Congenital: Connective tissue disease (Ehler’s-Danlos, Marfan’s) Bicuspid aortic valve |
| Physical Findings | Pain, hypotension, pulsatile abdominal mass (ruptured AAA classic triad) Systolic abdominal bruit Signs of GI bleeding or retroperitoneal hemorrhage | Syncope, hypotension/shock Pulse deficit, systolic BP differential between limbs Aortic regurgitation murmur Neurologic Deficits |