Abdominal aortic aneurysm: the role of clinical examination and opportunistic detection

Objectives: to investigate the method of discovery of abdominal aortic aneu rysms (AAA) in a district general hospital setting. Design: retrospective study. Materials and methods: rue analysed 198 patients with an AAA who presented to our unit over a 3-year period. The method of initial diagnosis, size of the AAA and whether this was palpable, irrespective of the method of detect ion, were recorded. Results: ninety-jive (48%) were discovered clinically, 74 (37.4%) during a radiological investigation, and 29 (14.6%) at laparotomy. Of the 74 AAAs fi rst detected radiologically, subsequent physical examination showed that 28 (37.8%) were in fact palpable and missed at presentation. The average size of those discovered clinically (6.48+/-1.32 cm) pens larger than those fou nd radiologically (5.37+/-1.44 cm, p<0.001) or at operation (5.43+/-1.48 cm , p=0.039). The average diameter of the palpable AAAs was also greater than that of the non-palpable AAAs (6.42+/-1.24 cm vs. 4.86+/-1.38 cm, p<0.001) . Conclusions: opportunistic detection of a clinically unsuspected aneurysm d uring clinical examination or investigation for another reason is the roast common way the diagnosis of an AAA is made. Almost half of the aneurysms w ere diagnosed clinically, but physical examination also missed more than a third of those detected radiologically. Despite technological advancement, clinical examination still plays a paramount role in the detection of AAAs. Larger AAAs are usually palpable and more likely to be defected on clinica l examination.