The value of evaluating the abdominal aorta in patients <50 years of age presenting for abdominal ultrasound

Abstract

Introduction Practitioners of US routinely include a survey of the abdominal aorta during abdominal US in accordance with international guidelines. Such practice is of uncertain value in younger patients. Methodology This study was a retrospective review of 2000 abdominal US examinations which included visualisation of the aorta in patients <50 years of age. Patient demographics and referral details were recorded, and US images and reports were reviewed for the presence of aortic and periaortic pathology. Results The most common indications for US were abdominal pain (1337, 44%), deranged liver function tests (453, 15%), nausea and/or vomiting (229, 8%), elevated inflammatory markers (146, 5%), pancreatitis (134, 4%) and pyrexia (127, 4%). Fewer than half (977, 49%) of the reports contained a comment regarding the aorta. Aortic pathology was reported in 2 (0.1%) cases. Both were reported as aortic ectasia and both represented a false‐positive diagnosis. One male patient had a known abdominal aortic aneurysm with endovascular aortic repair. No new aortic aneurysms were found. All cases of atherosclerotic disease were ignored, and none were reported. Periaortic pathology was encountered on 1 patient, but this was known. No case of new periaortic pathology was detected. Conclusion Routine and indiscriminate imaging of the abdominal aorta during abdominal US in patients <50 years of age is not evidence based. No new case of abdominal aortic aneurysm or new para‐aortic pathology was detected, all cases of atherosclerosis were ignored, and two false‐positive diagnoses of aortic ectasia were made.

Routine disclosure statements about ultrasound examinations during Covid‐19 pandemic are unhelpful and should be avoided

“…Indeed, certain common components of traditional "complete" examinations are simply redundant and only increase the work burden for the sonographer without a measurable benefit to the patient. [10][11][12] For this reason, some departments no longer routinely perform "complete" examinations, instead choosing to triage referrals for US according to the clinical question and then performing targeted examination protocols accordingly. 13 This approach works well for a large proportion of general radiology referrals.…”