While an uncommon condition, a leaking abdominal aortic aneurysm (AAA) is deadly if not recognized quickly.

How good is the physical examination for excluding AAA? Even if the physical exam is specifically directed to look for AAA, the sensitivity is still not good enough to rule out its presence (Sensitivity of 29% for AAAs of 3.0 to 3.9 cm, to 50% for AAAs of 4.0 to 4.9 cm, and 76% for AAAs of 5.0 cm or greater in diameter). So go pick up that ultrasound probe to look for it.

Lederle, F. A. et al. The rational clinical examination. Does this patient have abdominal aortic aneurysm? JAMA. 1999;281(1), 77.

Can ultrasound define the diameter of a AAA as accurately as a CT scan? Pretty close, though ultrasound will probably underestimate the diameter. Where it matters (at and around the bifurcation with a longitudinal view), ultrasound can come within 1cm of the CT diameter 95% of the time.

Knaut, A. al. Ultrasonographic measurement of aortic diameter by emergency physicians approximates results obtained by computed tomography. The Journal of Emergency Medicine, 2005; 28(2), 119-26.

Finally, how good are emergency physicians in detecting AAAs? Pretty good it seems, with 100% sensitivity (95% CI 1⁄4 89.5 to 100), 98% specificity (95% CI 1⁄4 92.8 to 99.8), 93% positive predictive value (27/29), and 100% negative predictive value (96/96).

Tayal VS, et al. Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years. Acad Emerg Med. 2003;10:867-871.