Exams and Tests

Most aortic aneurysms cause no symptoms and are found when you undergo a medical test or procedure for some other reason. Others are found only when you have symptoms.

The typical symptoms of an abdominal aortic aneurysm are not specific. This means that they could be caused by a number of different conditions.

• Your health care provider will probably not know at first what is causing your symptoms. He or she will rapidly consider the possibilities and develop a plan for systematically ruling each one out.
  
  
• This evaluation will start with the most serious conditions, and ruptured aneurysm is near the top of the list.
  
  
• If you are able, you can help by giving a focused, detailed description of how the symptoms started, how you were feeling before they started, and how the situation progressed once the symptoms started.

A full exam, with special attention to the cardiovascular system and abdomen, will give clues to the diagnosis.

• The health care provider may be able to feel a pulsating bulge in your belly or hear a loud pulse or other signs of aortic enlargement with the stethoscope.
  
  
• The exam findings will guide the rest of the evaluation.

Probably the first test that will be performed is an electrocardiogram (ECG or EKG). This is done to rule out a heart attack and other serious heart conditions.

• A series of electrical wires will be attached to your chest, arms, and legs. The ECG records the electrical impulses that control the beating of your heart.
  
  
• The rate and rhythm of your heartbeat is measured.
  
  
• Abnormalities in the ECG may point to heart damage.
  
  
• Often the ECG result is normal in uncomplicated aortic aneurysm.
  
  
• The test may be repeated after a short time to see if any changes have occurred in heart function.

An ultrasound, x-ray, computed tomography (CT) scan, angiogram, or magnetic resonance imaging (MRI) of the chest and abdomen may be done.

• Usually, an aneurysm shows up on plain radiographs only if it has become calcified as a result of atherosclerosis.
  
  
• Ultrasound will show abnormalities in the shape of your aorta. Echocardiography is a special type of ultrasound that shows the heart in great detail. This may be done in certain situations in which heart damage is suspected and/or the thoracic aorta is thought to be involved. A transesophageal echocardiogram is more sensitive and specific; the procedure involves swallowing a long tube with a probe at its distal end. Prior to placement of the probe, local anesthesia is applied to the back of the throat. This probe is very sensitive and can easily identify heart or aortic problems within a few minutes.
  
  

• Aortography is an x-ray procedure done after a contrast or x-ray dye is injected into the blood stream. This study highlights abnormalities, such as bulges, and confirms the diagnosis of aneurysm. Aortography involves inserting a catheter inside the body and aorta, with its associated risks.

• A CT scan is a fancy x-ray that shows much more detail of the organs, blood vessels, and other structures inside the body. It requires the use of a dye, which can damage the kidney in rare cases.
  
  
• MRI is also a fancy, highly specialized technique that gives a very detailed view of the inside of the body.
  
  
• CT scan and MRI have largely replaced aortography. The only hazard of CT scan and MRI is that the patient is left unattended in a radiological suite for about 20-30 minutes, which may not be advisable for a patient with low blood pressure.