This elderly lady presented to the Emergency Department acutely unwell with epigastric pain. She was hypotensive and tender in the epigastrium. The attending clinicians were concerned about the possibility an abdominal aortic aneurysm.
In the initial tranverse views a hypoechoic region is noted to the left of the vertebral body. Closer inspection reveals this region is separate to the abdominal aorta which is normal calibre
This case illustrates the appearance of large para-aortic nodes- further history determined the presence of a Non Hodgkins lymphoma that was under treatment. Differentiation of para-aortic nodes from the aorta is an important distinction. Bedside ultrasound remains the diagnostic method of choice in the unstable patient with a suspected abdominal aortic aneurysm. There is a single case report of a false positive report in the literature in the setting of an undiagnosed malignant para-aortic lymph node.
See Lyon M, Branham L, Ciamillo L, Blaivas M. False Positive abdominal aortic aneurysm on bedside emergency ultrasound J Emerg Med 2004 26(2): 193-6