title: Abdominal aortic aneurysm: the role of clinical examination and opportunistic detection.
abstract: OBJECTIVE
  to investigate the method of discovery of abdominal aortic aneurysms (AAA) in a district general hospital setting.
  
  
  METHODS
  retrospective study.
  
  
  METHODS
  we 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 detection, were recorded.
  
  
  RESULTS
  ninety-five (48%) were discovered clinically, 74 (37.4%) during a radiological investigation, and 29 (14.6%) at laparotomy. Of the 74 AAAs first 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) was larger than those found 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 during clinical examination or investigation for another reason is the most common way the diagnosis of an AAA is made. Almost half of the aneurysms were 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 detected on clinical examination.
authors.affiliation: Department of Surgery, Royal Preston Hospital, Preston, England, UK.
authors.forename: C D
authors.initials: CD
authors.lastname: Karkos
authors.forename: U
authors.initials: U
authors.lastname: Mukhopadhyay
authors.forename: I
authors.initials: I
authors.lastname: Papakostas
authors.forename: J
authors.initials: J
authors.lastname: Ghosh
authors.forename: G J
authors.initials: GJ
authors.lastname: Thomson
authors.forename: R
authors.initials: R
authors.lastname: Hughes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001466:Barium Sulfate; D003287:Contrast Media; D004733:Enema; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010173:Palpation; D010808:Physical Examination; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014567:Urography
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate