Suspected Abdominal Aortic Aneurysm (AAA) on
X-ray
Of
course, we see the aorta on x-ray only when its walls contain calcium, so it is
possible that an aneurysm could be present but not detectable on x-ray.
The abdominal aorta frequently shows calcium in its walls - and commonly
becomes elongated and tortuous -
as a typical consequence of aging, and there is no cause for alarm if the
A-to-P diameter stays under 3.8cm.
If
the A-to-P measurement exceeds 3.8cm, however, it is classified as an
aneurysm. At this point, it
is necessary to refer the patient for medical evaluation.
The specific type of referral could vary from one geographic area to
another, but it is usual that the typical vascular surgeon works only on
peripheral vascular conditions, and it is usually the heart surgeon who would
work on an abdominal aorta. You
could call the office of a vascular surgeon or heart surgeon in your area and
inquire about this.
From
3.8cm to 5cm the aneurysm is simply followed via diagnostic ultrasound.
If it shows no enlargement, no surgery is required, but the monitoring
continues. When an aneurysm reaches
5cm, surgery is scheduled, and the surgery can be anticipated and scheduled
according to convenience. If an AAA
reaches 6cm, it is considered a medical emergency, and surgery needs to be done
immediately, as the risk of rupture becomes very high at this size.
A
6cm AAA is an absolute contraindication to any form of chiropractic care,
because the patient should be on his way to surgery instead of even being
in a chiropractic office! An
individual being monitored for a 3.8 to 5cm AAA can certainly be treated, but it
would be wise to avoid side-posture torque, drop-table, and other forceful
procedures and to carefully document exactly what is being done at each
treatment. While it is exceeding
unlikely that routine manipulative procedures could cause the rupture
of an AAA, it must be recognized that an AAA could rupture spontaneously, and if
it did so in a chiropractor’s office, you can imagine the consequences!
Examples of procedures that would be safe to do would be:
