Hello all,

FYI regarding pros and cons of giving IV contrast in the setting of
suspected AAA or question of leaking/dissecting AAA. Bottom line, if the
patient is even borderline unstable and you need a yes/no answer with
respect to "is there a AAA", then a non-contrast study is the way to go.
If you have a patient with a know AAA and you want to know if it is
leaking/dissecting and you have some time, then IV contrast is the better
test as per Bea's repsonse below. Make sure you understand this concept
because some of the radiology residents on the other side of the phone may
not.

TY,
Kaveh

> -----Original Message-----
> From: Carlin MD, Beatrice
> Sent: Thursday, September 05, 2002 10:39 AM
> To: Hahm MD, Michael
> Cc: Ilkhanipour, Kaveh
> Subject: RE: DEM protocols for AAA
>
> Dear Mike,
> If the primary question is whether there is a leak, contrast does not
> need to be given. also if the only question is size or whether an
> aneursysm exists, contrast is unnecessary. Obviously to judge increase
> in size you need a comparison study. For dissection contrast MUST be
> given as the only definite way to make the dx. is to see the flap with
> contrast on either side.
>
> Generally all of the elective OP studies we do to evaluate aneurysm is
> for surgical planning. These require IV contrast as the idea is to see
> the relationship to renal art. and iliacs, as well as size for stent
> placement.
>
> As you know, the level of information always goes up with IV contrast,
> and if the ordering physician is uncertain as to source of the abdomenal
> complaint the preference is to give constrast (usually oral and IV) and
> get as much info as possible the first time we scan.
>
> I know this is a long answer, but generally these questions are not as
> clean as you might want. I hope this helps.
>
> By the way, there is no recent change with aorta protocols.
>
> Bea Carlin
>
> -----Original Message-----
> From: Hahm MD, Michael
> Sent: Wednesday, September 04, 2002 8:07 PM
> To: Carlin MD, Beatrice
> Subject: DEM protocols for AAA
>
>
> hey Dr. Carlin,
>
> I had a case last night where the DEM ordered a ct Ab
> for AAA. pt kendrick mr 032852. They already knew that
> the patient had a infrarenal AAA. Dr. Ilkanoupur ( think the
> spelling is right) told me that there is a new protocol where
> AAA studies are done without contrast and that has been discussed
> with you. I asked what they were looking for and they said
> dissection/leak/increase in size. I ended up doing the study
> with contrast after waiting for the labs. I just want to know
> if that is the official protocol
>
> mike