Diagnosis of Aortic Aneurysm
Most patients are not aware of an aneurysm at diagnosis. The diagnosis is gleaned from an incidental ultrasound for unrelated reasons or a pulsating mass is noted on an otherwise routine physical exam.
Aortic aneurysm can progress to rupture without warning or predictive symptoms. For this reason, screening is important for groups at risk:
- Asymptomatic patients with risk factors for aneurysm: smoking, male gender, advanced age, Caucasian, atherosclerosis, family history of aneurysm, or connective tissue disorder (Marfan, Ehlers-Danlos, Loey-Dietz syndromes) in the patient or family.
- Physical exam that demonstrates a pulsating abdominal mass or aneurysms in places other than the aorta.
- Signs and symptoms: such as abdominal, chest, or back pain, limb ischemia, different blood pressures in opposite limbs, etc.
Emergency vs. Non-Emergency Diagnosis
Whether ultrasound of the aorta or more involved testing such as CT are used depends on the presentation.
- Ultrasound: In emergencies, bedside ultrasound offers the fastest assessment in hemodynamically unstable patients that can prompt the decision for sending them to the OR. Ultrasound is also useful in screening and in following patients with an established diagnosis.
- CT Scan: Alternately, symptomatic aneurysm patients who are stable are usually evaluated with the addition of CT scans.
Currently, “biomarkers” for inflammatory changes associated with aortic aneurysms are not useful. These include white blood cell count, fibrinogen level, D-dimer, troponin T, N-terminal pro-brain natriuretic peptide, and C-reactive protein (CRP). On-going research is being conducted in attempts to relate abnormal levels of these to the presence of aneurysms, which may make them important diagnostic and predictive measures in the future. Genetic testing is helpful in identifying congenital connective tissue disorders that are prone to aortic wall weakening, such as Marfan and other syndromes.