A 60 year old male presents to ED with complaint of abdominal pain worsening for last few weeks, now limiting his daily activities. His HR 80, BP 130/70, afebrile. RR 18. His current pain is 5/10,  On abdominal exam he is moderately tender in central abdomen.

Bedside USG is performed and following image is saved.

Answers:

1. This is Transverse image of distal Abdominal aorta, ( shadow of vertebral body is visible). there is AAA measuring 6cm, with an intramural thrombus. The actual lumen of aorta is actually very small. Remember AAA is always measured from outerwall to outerwall for the same reason and compare measurement in longitudinal plane.

1. Urgent CT abdomen to rule out leak or rupture , followed by referral to vascular surgeon.

Ultrasound is very sensitive in diagnosis presence or absence of AAA , but does not rule out rupture or leak.