Lifestyle

The One-Time Ultrasound That Can Spot a Dangerous Bulge in the Aorta, and Why Many Checkups Never Order It

By Mike Harper · November 6, 2026

A yearly checkup often covers blood pressure, cholesterol and a few blood tests. One screening most primary care visits never mention is a single ultrasound of the belly that can find a bulge in the body’s main artery before it becomes an emergency.

That bulge is an abdominal aortic aneurysm, or AAA. The U.S. Preventive Services Task Force defines an AAA as aortic enlargement with a diameter of 3.0 cm or larger. The aorta runs from the heart through the chest and abdomen. Most AAAs cause no symptoms until they rupture. The task force notes that the risk for death with rupture is as high as 81%.

This piece is about the screening test, not about warning signs. Many people who qualify for the scan never hear about it at a routine visit, even though the recommendation has been on the books for years.

Who should get the one-time ultrasound. For men ages 65 to 75 who have ever smoked, the USPSTF gives a Grade B recommendation for one-time screening with ultrasonography. An “ever smoker” is commonly defined as someone who has smoked 100 or more cigarettes. Smoking is listed among the strongest risk factors for AAA prevalence, growth and rupture.

For men in the same age range who have never smoked, the grade is C. Clinicians should selectively offer screening rather than screen every man in the group. The task force says the overall benefit of screening all never-smokers is small, so the decision should weigh medical history, family history, other risk factors and personal values.

The advice for women is different. The USPSTF recommends against routine screening for women who have never smoked and have no family history of AAA (Grade D). For women ages 65 to 75 who have ever smoked or have a family history of AAA, it concludes that the evidence is insufficient to weigh benefits and harms (I statement). That makes the question worth raising with a doctor rather than assuming the answer.

How the test works. The standard approach is abdominal duplex ultrasonography. The task force describes it as noninvasive, simple to perform, and highly accurate, with reported sensitivity of 94% to 100% and specificity of 98% to 100%. It does not use radiation. Physical exam alone is not recommended for screening, and CT is not preferred as a screening method because of radiation exposure.

How often. Once. All of the large screening trials the task force reviewed used a one-time approach. Follow-up depends on what the scan finds. Treatment of a detected AAA depends on size, the risk of rupture and the risk of surgery. Many screen-detected aneurysms are small and are watched with repeat ultrasound rather than repaired right away. Larger aneurysms may need surgical evaluation.

Risk factors the task force lists include older age, male sex, smoking and having a first-degree relative with an AAA. Other factors associated with higher risk include a history of other vascular aneurysms, coronary artery disease, cerebrovascular disease, atherosclerosis, high cholesterol and high blood pressure. The recommendation applies to asymptomatic adults. Clinicians may skip screening when a person cannot undergo surgery or has a short life expectancy.

If you are a man between 65 and 75, especially if you ever smoked, ask whether you have ever had a one-time abdominal aortic ultrasound. If the answer is no, ask whether you fit the group the USPSTF says should be screened, or selectively offered screening. Bring the same question if you are a woman with a smoking history or a close relative who had an AAA. The scan takes little time. Missing it can mean a silent bulge goes unnoticed for years.

This article is for general information and is not medical advice. Ask your doctor whether AAA screening is right for you. This article was produced with the assistance of AI and fact-checked against the sources cited by LightWave Reports.