Casual Detection of an Abdominal Aortic Aneurysm Thanks to a Trainee-made Ultrasound with Two Subsequent "domino" Diagnoses: Case Report and Insights on the Role of Ultrasound Courses

Overview

Journal J Ultrasound

Publisher Springer

Specialty Radiology

Date 2024 Dec 21

PMID 39709314

Authors

Vittorio Oteri

Francesco Galeano

Andrea Conti

Giovanni Scavone

Andrea Tumminia

Francesco Frasca

Raffaella Romano

Marcello Romano

Affiliations

Soon will be listed here.

Abstract

Early detection of abdominal aortic aneurysm (AAA) is crucial as untreated lesions can be life-threatening. We describe the case of a fortuitous ultrasound (US) detection of AAA by a trainee which allowed two subsequent "domino" diagnoses. A 69 y.o. male underwent US to evaluate prostate and bladder. He was a heavy smoker affected by hypertension and dyslipidemia. An endocrinology resident and ultrasound trainee started the exam accidentally from the epigastrium and found a fusiform aneurysmal lesion. Subsequent computed tomography (CT) scan confirmed the diagnosis of AAA and incidentally revealed a colon adenocarcinoma and a diffuse non-Hodgkin lymphoma. This case report underlines the importance of extending the abdominal US examination to the aorta in patients over 60 years of age (especially in those people with multiple risk factors for AAA) and emphasizes the critical role of organizing hands-on-patient US courses with a multidisciplinary approach to optimize the training of future sonographers.

References

Bains P, Oliffe J, Mackay M, Kelly M . Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review. Am J Mens Health. 2021; 15(2):15579883211001204. PMC: 7970195. DOI: 10.1177/15579883211001204. View

Johnston K, Rutherford R, Tilson M, Shah D, Hollier L, Stanley J . Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for.... J Vasc Surg. 1991; 13(3):452-8. DOI: 10.1067/mva.1991.26737. View

Hirsch A, Haskal Z, Hertzer N, Bakal C, Creager M, Halperin J . ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for.... Circulation. 2006; 113(11):e463-654. DOI: 10.1161/CIRCULATIONAHA.106.174526. View

Kent K, Zwolak R, Egorova N, Riles T, Manganaro A, Moskowitz A . Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010; 52(3):539-48. DOI: 10.1016/j.jvs.2010.05.090. View

Chaikof E, Dalman R, Eskandari M, Jackson B, Lee W, Mansour M . The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2017; 67(1):2-77.e2. DOI: 10.1016/j.jvs.2017.10.044. View

Fleming C, Whitlock E, Beil T, Lederle F . Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005; 142(3):203-11. DOI: 10.7326/0003-4819-142-3-200502010-00012. View

Svensjo S, Bjorck M, Wanhainen A . Update on screening for abdominal aortic aneurysm: a topical review. Eur J Vasc Endovasc Surg. 2014; 48(6):659-67. DOI: 10.1016/j.ejvs.2014.08.029. View

Barkin A, Rosen C . Ultrasound detection of abdominal aortic aneurysm. Emerg Med Clin North Am. 2004; 22(3):675-82. DOI: 10.1016/j.emc.2004.04.009. View

Mai T, Woo M, Boles K, Jetty P . Point-of-Care Ultrasound Performed by a Medical Student Compared to Physical Examination by Vascular Surgeons in the Detection of Abdominal Aortic Aneurysms. Ann Vasc Surg. 2018; 52:15-21. DOI: 10.1016/j.avsg.2018.03.015. View

10.

Concannon E, McHugh S, Healy D, Kavanagh E, Burke P, Moloney M . Diagnostic accuracy of non-radiologist performed ultrasound for abdominal aortic aneurysm: systematic review and meta-analysis. Int J Clin Pract. 2014; 68(9):1122-9. DOI: 10.1111/ijcp.12453. View

11.

Shreibati J, Baker L, Hlatky M, Mell M . Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries. Arch Intern Med. 2012; 172(19):1456-62. DOI: 10.1001/archinternmed.2012.4268. View

12.

Gagnier J, Kienle G, Altman D, Moher D, Sox H, Riley D . The CARE guidelines: consensus-based clinical case reporting guideline development. BMJ Case Rep. 2013; 2013. PMC: 3822203. DOI: 10.1136/bcr-2013-201554. View

13.

Benson R, Meecham L, Fisher O, Loftus I . Ultrasound screening for abdominal aortic aneurysm: current practice, challenges and controversies. Br J Radiol. 2018; 91(1090):20170306. PMC: 6350491. DOI: 10.1259/bjr.20170306. View

14.

Corrado G, Durante A, Genchi V, Trabattoni L, Beretta S, Rovelli E . Prevalence of previously undiagnosed abdominal aortic aneurysms in the area of Como: the ComoCuore "looking for AAA" ultrasonography screening. Int J Cardiovasc Imaging. 2016; 32(8):1213-7. DOI: 10.1007/s10554-016-0911-3. View

15.

Owens D, Davidson K, Krist A, Barry M, Cabana M, Caughey A . Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 2019; 322(22):2211-2218. DOI: 10.1001/jama.2019.18928. View

16.

Patel S, Benninger B, Mirjalili S . Integrating ultrasound into modern medical curricula. Clin Anat. 2017; 30(4):452-460. DOI: 10.1002/ca.22864. View

17.

Oteri V, Occhipinti F, Gribaudo G, Marastoni F, Chisari E . Integration of ultrasound in medical School: Effects on Physical Examination Skills of Undergraduates. Med Sci Educ. 2021; 30(1):417-427. PMC: 8368431. DOI: 10.1007/s40670-020-00921-4. View

18.

Narula J, Chandrashekhar Y, Braunwald E . Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiol. 2018; 3(4):346-350. DOI: 10.1001/jamacardio.2018.0001. View