BACKGROUND: Screening for aneurysm of abdominal aorta (AAA) in the general population is costly and unrealistic, but examination of the abdominal aorta appears reasonable in a high risk cardiological population. METHOD: As the abdominal aorta is easily accessible to standard transthoracic echocardiographic equipment, we tested this hypothesis in 301 consecutively referred patients (182 men, 119 women, mean age 58.6 +/- 16.5 years) by imaging the abdominal aorta at the end of the cardiac examination. RESULTS: After exclusion of three patients operated on for AAA before, the native infrarenal segment most often involved in AAA was visualised in 297 out of 298 patients (99.7%), and the aortic bifurcation was seen satisfactorily in 285 of them (95.6%). The abdominal aorta was dilated (> or = 2 cm) in 44 patients (15%), all but one of whom were > 50 years old; 17 of these (5.7%) had AAA defined as segmental dilation with a maximum diameter of > or = 3 cm (15 men, 2 women, age 67.4 +/- surgical repair and one endovascular repair within one year after completion of the data collection. Their mean age was 70.1 +/- 7.9 years, ranging from 58 to 80 years. No significant surgical morbidity and no mortality was observed. CONCLUSIONS: Prevalence of dilative alterations of the abdominal aorta is high in cardiological patients. Visualisation during transthoracic echocardiography of the most important infrarenal segment is nearly always feasible (99.7%), including its bifurcation (95.6%). Since detection of life-threatening but asymptomatic AAA may save lives by offering safe elective surgical treatment or stenting, opportunistic examination of the abdominal aorta during routine transthoracic echocardiography, which involves little time and no additional cost, would appear to be highly effective and should be included in routine examinations, at least in patients over 50 years of age.