Health Dictionary

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.

Cardiology

[MollPowell2011-1] 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.

[FinkLederle2000-2] 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.

[FinkLederle20002-3] 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.

[Chaikof-2009-4] 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)

[pmid23473760-5] 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.

[1]

[2]

[3]

[4]

[5]