Real-Time Screening for AAA: POCUS Helps Bridge the Preventive Care Gap
This article also appears in the Southern Medical Association News at this link.
Case Presentation
A 68-year-old male with a history of hypertension and smoking presents to the primary care office for a routine visit—his first in over five years. Known for avoiding doctors, he came in at the encouragement of his daughter, who noted his blood pressure had been elevated at home.
In the office, his BP is 148/92 mmHg, and his exam is otherwise unremarkable. While reviewing preventive care needs, the provider notes that he qualifies for a one-time abdominal aortic aneurysm (AAA) screening. With a point-of-care ultrasound (POCUS) device readily available, she performs a focused abdominal aortic scan during the visit.
She places the curvilinear probe in the transverse plane just above the umbilicus. What do you see, and what’s the diagnosis?
Figure 1. Transverse view of the distal abdominal aorta measuring 6.14 cm.
POCUS Findings
The scan reveals a fusiform dilation of the infrarenal aorta measuring 6.14 cm in diameter at its largest. This is well above the 3.0 cm threshold for aneurysm and exceeds the 5.5 cm cutoff at which surgical evaluation is typically indicated. There are no signs of rupture or dissection noted.
POCUS Technique for Abdominal Aorta Evaluation
Normal POCUS appearance: A normal abdominal aorta appears as a round, pulsatile, anechoic structure with clearly defined echogenic walls and a maximum diameter under 3.0 cm.
Scanning technique: The aorta should be imaged in both transverse and longitudinal planes, extending from the xiphoid process to the iliac bifurcation. To correctly identify the aorta, make sure to visualize the vertebral shadow first. The aorta sits just anterior to it.
Measurement protocol: Measurements should be taken outer wall to outer wall in the transverse view at three key levels—proximal (near the celiac trunk), mid (at the level of the renal arteries), and distal (just above the bifurcation). A normal abdominal aorta should measure less than 3.0 cm in diameter. Figures 2 and 3 show ultrasound images of a normal aorta.
Figure 2. Transverse view of a normal distal aorta measuring 1.85cm. Note the bowel gas on the left side of the image obscuring the IVC.
Figure 3. Transverse view of a normal distal aorta annotated to show the vertebral and bowel gas shadows.
Image optimization tips: If bowel gas limits visualization, graded compression with the probe may help displace overlying bowel loops. Alternatively, move the probe to the side to avoid the bowel gas as was done to obtain the image in Figure 2. Ideally, patients should fast for 4–6 hours to reduce bowel gas, although adequate images can often still be obtained without fasting.
Evaluating the iliac arteries: The bifurcation into the iliac arteries should be visible near the inferior portion of the scan. The common iliac arteries can be evaluated, and a normal diameter is typically less than 1.5 cm. Figures 4 and 5 demonstrate ultrasound images of normal iliac arteries. Enlargement of the iliac arteries should prompt further evaluation, particularly in the setting of a known or suspected aortic aneurysm.
Figure 4. Transverse view of iliac arteries just at the bifurcation of the aorta. Both arteries measure <1.5 cm.
Figure 5. Transverse view of iliac arteries with annotations. IVC -inferior Vena Cava; RIA – right iliac artery; LIA – left iliac artery.
Evidence
Point-of-care ultrasound has excellent accuracy for detecting AAA. A recent meta-analysis of emergency department-performed POCUS for AAA showed a pooled sensitivity of 98.33% and specificity of 99.84%.[1] A Canadian study found that AAA screens in rural family physician offices took on average 212 seconds and showed 100% sensitivity and specificity.[2] The U.S. Preventive Services Task Force recommends a one-time screening for AAA via ultrasonography in men aged 65 to 75 who have ever smoked.[3]
Incorporating POCUS into the primary care setting allows this screening to be completed during a single visit, improving adherence to guidelines—especially for patients unlikely to follow through with imaging referrals due to remote location or other reasons.[2] Focused AAA scanning is one of the most straightforward POCUS applications to learn, requiring minimal training to perform effectively.
Case Resolution
The provider promptly contacted vascular surgery and arranged same-day CT angiography. The patient was admitted and underwent elective endovascular aneurysm repair (EVAR) within the week.
Impact of POCUS
This case illustrates how POCUS can support timely, guideline-based preventive care in primary care settings. In just a few minutes, the provider identified a life-threatening diagnosis that might otherwise have gone undetected until rupture. By integrating POCUS into routine visits, clinicians can improve patient outcomes, streamline workflows, and close preventive care gaps If you're new to POCUS in primary care and wondering where to start, this article highlights foundational applications that deliver the most impact with minimal training.
AAA screening is a quick, high-value application of POCUS that fits seamlessly into primary care practice. For eligible patients, completing this screen during the office visit improves adherence to guidelines and may lead to life-saving interventions. With appropriate training and tools, primary care providers can confidently perform this scan in real-time—right when and where it’s needed most.
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Authored by Tatiana Havryliuk, MD
References
Shaban EE, Yigit Y, Alkahlout B, et al. Enhancing clinical outcomes: Point of care ultrasound in the precision diagnosis and Management of Abdominal Aortic Aneurysms in emergency medicine: A systematic review and meta-analysis. J Clin Ultrasound. 2025;53(2):325-335. doi:10.1002/jcu.23850
Blois B. Office-based ultrasound screening for abdominal aortic aneurysm. Can Fam Physician. 2012;58(3):e172-e178.
US Preventive Services Task Force, Owens DK, Davidson KW, et al. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322(22):2211-2218. doi:10.1001/jama.2019.18928