Elderly male with syncope…


One of my colleagues had an interesting case the other day.  An elderly patient came in after a syncopal event.  The only complaint was mild lower back discomfort.  Bedside ultrasound revealed the etiology (later visualized on this CT):
AAA 2

AAA 3

This CT shows a large infrarenal abdominal aortic aneurysm (AAA) that extended down into the iliac arteries bilaterally.   The aneurysm had intraluminal clot and concern for impending complete rupture near the iliac bifurcation.  The patient was expeditiously taken to the OR for operative repair.

This is a good case that demonstrates the utility of bedside ultrasound in the ED.  Syncope is an event that can be caused by a large variety of pathophysiology, AAA being one of the most feared.  It is very important in this situation to have a high index of suspicion and make the diagnosis quickly, accurately, and disposition the patient to the appropriate care.

For a brief tutorial on bedside aortic ultrasonography I refer you to a great blog from Mount Sinai:

Sinai EM Ultrasound

Image Contributor:  Rupi Chima, MD

Author:  Russell Jones, MD

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EMREMS: Radiology in Emergency Medicine

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