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 interrogation of a prospectively gathered computerized database. Setting: The study was performed at a regional vascular surgery unit. Subjects: Six hundred fifty-two consecutive patients were admitted to this unit with suspected ruptured abdominal aortic aneurysm between January 1, 1989, and December 31, 1996. Seventy-four patients (11.3%) in whom the diagnosis was in doubt on clinical grounds alone underwent urgent CT. A total of 47 men and 27 women with a median age of 73 years (range, 52 to 86 years) were evaluated. Main Outcome Measures: CT and operative findings 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 specificity of CT when compared with operative findings were therefore 79% and 77%, respectively. Conclusions: These data indicate that CT has little additional diagnostic value. If in the opinion of an experienced vascular surgeon rupture cannot be excluded on clinical grounds alone, and the patient has no medical contraindications to abdominal aortic aneurysm repair, then the patient should be taken directly to the operating department.