Tests

1st tests to order

abdominal ultrasound

Test
Result
Test

Definitive test (sensitivity and specificity of 92% to 99% and nearly 100%, respectively).[1][2]​​​​[77]​​

The ultrasound is performed perpendicular to the aortic axis as oblique views may overestimate the true aortic diameter.​[2][5][79]​​​

Unfortunately, ultrasound offers little utility in imaging aneurysms close to the origins of, or proximal to, the renal arteries.[80][81]

Result

abdominal aortic dilation of >1.5 times the expected anterior-posterior diameter of that segment, given the patient's sex and body size; the most commonly adopted threshold is a diameter of ≥3 cm

Tests to consider

computed tomography angiography (CTA)/CT

Test
Result
Test

In selected patients, CT scan is recommended as a first-line investigation to evaluate patients thought to have AAA presenting with recent-onset abdominal or back pain, particularly in the presence of a pulsatile epigastric mass or significant risk factors for AAA.[76]​ May demonstrate retroperitoneal hematoma, discontinuity of the aortic wall, or extravasation of contrast into the peritoneal cavity, which are all signs of rupture.[13][85]

Also useful in diagnosing aortic aneurysms close to the origins of, or proximal to, the renal arteries.[5][81][85]​​

The first choice for pre- and intraoperative planning; 0.5 mm slices are desirable and 3D reconstruction is essential for accurate planning.​[79][86]

Result

abdominal aortic dilation of >1.5 times the expected anterior-posterior diameter of that segment, given the patient's sex and body size; the most commonly adopted threshold is a diameter of ≥3 cm

positron emission tomography-computed tomography (PET-CT)

Test
Result
Test

Used for the diagnosis and follow-up of aortic pathologies associated with inflammatory aneurysm, aortic infection (including mycotic AAAs), infected prostheses, and stent grafts.[3][83]

Result

uptake of radiotracer in areas of active infection or inflammation

erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP)

Test
Result
Test

Supports a diagnosis of possible inflammatory AAA.[5]

Result

elevated

CBC

Test
Result
Test

Leukocytosis and a relative anemia on CBC with positive blood cultures are indicative of infectious AAA.

Result

leukocytosis, anemia

blood cultures

Test
Result
Test

Leukocytosis and a relative anemia on CBC with positive blood cultures are indicative of infectious AAA.

Result

positive

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