Patients undergoing transthoracic echocardiography often have atherosclerotic vascular disease and may be at risk for the development of abdominal aortic aneurysms. We therefore examined the abdominal aorta by ultrasound in 323 consecutive patients undergoing routine two-dimensional transthoracic echocardiography over a 6-month period. Measurements were made of aortic length (diaphragm to most caudal portion visualized) and maximum diameter. The study group comprised 169 men and 154 women with an average age of 57 +/- 19 years (range 13 to 94). The abdominal aorta was imaged in 265 (82%) patients. The average aortic length visualized was 13.0 +/- 4.6 cm, the average diameter 1.7 +/- 0.4 cm, and the time required for screening < 5 minutes. Seven (3%) patients were identified as having abdominal aortas > or = 2.5 cm in diameter: 1 with an aneurysm measuring 6.7 cm in diameter and 6 with mild dilatations measuring 2.5 to 3.0 cm in diameter. One of the patients with mild aortic dilatation was subsequently found to have an infrarenal aneurysm measuring 3.5 cm in diameter. Aortic dilatation was associated with male gender (p = 0.0006) and older age (p = 0.05) but was not associated with a history of ischemic heart disease (p = 0.16). From these results, we conclude that screening for abdominal aortic aneurysms in patients undergoing transthoracic echocardiography is practical and clinically useful. Only a small number of these patients are identified as having aneurysms, but the low cost and brief time required suggest that routine screening in this population may be worthwhile.