Images come from Drs. Brandon Penn and Anne Daul, who used bedside ultrasound to evaluate an elderly patient who developed hypotension shortly after arrival to the MTC. Their patient presented after a ground-level fall and initial FAST exam was negative. The patient complained of back pain.
What US exam would you perform next?
Image 1
Here we see an abdominal aortic aneurysm. Identification of an aneurysm and a convincing clinical history suggestive of rupture should prompt immediate vascular surgery consultation. Remember that the majority of AAAs will rupture into the retroperitoneum. Rupture is challenging to identify on bedside ultrasound as blood in the retroperitoneum is tightly confined, and thus does not appear black like free fluid in the abdomen. The rupture in this ultrasound is labeled on Image 2. Based on this scan vascular surgery was emergently consulted and the patient was taken to the OR for repair.
Image 2
Date: May 2015