THE VALUE OF COMPUTED-TOMOGRAPHY IN THE ASSESSMENT OF SUSPECTED RUPTURED ABDOMINAL AORTIC-ANEURYSM

Objective: The objective of this study was to determine the diagnostic value of computed tomography (CT) in patients with suspected ruptured abdominal aortic aneurysm. Study Design: The study was an interrogati on of a prospectively gathered computerized database. Setting: The stu dy was performed at a regional vascular surgery unit. Subjects: Six hu ndred fifty-two consecutive patients were admitted to this unit with s uspected ruptured abdominal aortic aneurysm between January 1, 1989, a nd December 31, 1996. Seventy-four patients (11.3%) in whom the diagno sis was in doubt on clinical grounds alone underwent urgent CT. A tota l of 47 men and 27 women with a median age of 73 years (range, 52 to 8 6 years) were evaluated.Main Outcome Measures: CT and operative findin gs were compared. Results: CT correctly diagnosed rupture in 22 of 28 patients who underwent operation and correctly excluded rupture in 30 of 39 patients who underwent operation. The sensitivity and specificit y of CT when compared with operative findings were therefore 79% and 7 7%, respectively. Conclusions: These data indicate that CT has little additional diagnostic value. If in the opinion of an experienced vascu lar surgeon rupture cannot be excluded on clinical grounds alone, and the patient has no medical contraindications to abdominal aortic aneur ysm repair, then the patient should be taken directly to the operating department.