Ninety-two patients with a pulsating abdominal mass and suspected abdominal aortic aneurysm (AAcA) were examined by ultrasonography. We diagnosed 48 cases (52%) of AAA and 5 unexpected lesions ventral to the aorta (5%), but in 39 cases (42%) we were not able to explain the symptom in spite of extensive diagnostic efforts and follow-up. Changes of the aorta or transmission of the pulse by adjacent structures are the main cause of a pulsating abdominal mass. Ultrasound examination appears to be optimal screening method for diagnosing AAA as well as the other symptoms no further diagnostic efforts are necessary after a negative ultrasound study.
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