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Question
A male in his 70s presents to the emergency department after a syncopal episode with hypotension and abdominal pain.
What's the diagnosis? What's the correct measurement?
Answer
This patient has a AAA with a large mural thrombus. The patient is symptomatic and there is concern for aortic rupture.
POCUS has a high sensitivity and specificity for diagnosing AAA but is still limited in diagnosing rupture.
The highest risk of rupture is in those with AAAs > 5.5 cm in males and 5.0 cm in females.
Remember to correctly measure the aorta by including the mural thrombus in your measurement. Mural thrombus presence has been associated with higher growth rates and increased risk of rupture.
References
Jeffers K, Keim SM, et al. What is the Utility of Point-of-Care Ultrasound for Diagnosing Abdominal Aortic Aneurysm? J Emerg Med. 2026 Mar;82:82-87. doi: 10.1016/j.jemermed.2025.12.006.