Abdominal Aorta Ultrasound Cheat Sheet Clinical Application



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Abdominal Aorta Ultrasound Cheat Sheet


Clinical Application

Basics

  • 90% mortality rate of rupture

  • Suspect AAA in any pt >60 yo with abdominal or back pain

  • Screen all > 60 yo males with hx of HTN or smoking at least once

  • Small AAAs (<4.5 cm) rupture less frequently than larger AAAs

Sensitivity & Specificity

  • High sensitivity for presence of AAA

  • Poor sensitivity for acute rupture

  • Rupture usually into retroperitoneal space & US isn’t great at detecting retroperitoneal bleeds


Anatomy

Normal Anatomy

  • Aorta bifurcates at umbilicus (T5)

  • 1st branch: celiac trunk

  • Hepatic and splenic artery come off CT

  • 2nd branch: super mesenteric artery

  • SMA is about 1 cm caudal to CT & runs parallel to aorta

Anatomy of AAA

  • Two types of AAA: fusiform and saccular

  • Fusiform: dilation of entire circumference

  • Saccular: asymmetric out pouching

  • Fusiform more common

  • Majority of AAA are infrarenal

  • Aneurisms can extend into iliacs


Technique

Basics

  • Curvilinear probe (best) or phased array

  • Start just caudal to xyphoid process

  • End caudal to bifurcation (umbilicus)

  • Transverse view: probe marker to pt’s rt

  • Longitudinal view: probe marker to pt's head

  • Adjust gain until vessel lumen is black (makes identifying an intra-luminal thrombus easier)

  • Always scan in both planes (trans & longitude)

Images

  • Identify vertebral body to get oriented

  • Vertebral body: horseshoe shaped with hyperechoic anterior & posterior shadowing

  • Aorta is anterior & slightly left of vertebral body

  • IVC is anterior & right of vertebral body

  • Identify the CT, SMA, and bifurcation

Measurements

  • Measure in transverse view

  • Measure from outer wall to outer wall

  • Normal aorta: < 3 cm


Pathology

Dissections

  • A dissection looks like a flap in the vessel area

  • Flaps are the intima floating out into the vessel

  • Watch out for these. They can be subtle!

Aneurisms

  • Aneurisms look like a widening of the aorta

  • Scan the whole length of the abdominal aorta, so you don’t miss one!

  • Saccular aneurisms are easier to miss than fusiform, so look for them

General

  • Measure from outer walls, otherwise a mural thrombus or plaque may cause you to underestimate diameter

  • Transverse views at a slight angle can exaggerate the diameter

  • Ectatic aortas are not straight and can take an irregular track through abdomen

  • Just because there isn't intraperitoneal fluid doesn't mean there isn't an acute rupture (aortas are retroperitoneal)

  • Aorta and IVC can be confused in longitudinal view: aorta is rounder, less compressible, & has brighter thicker walls

  • If clinical suspicion for AAA is high & ultrasound is equivocal, get a CT with contrast


Tips and Tricks

  • Bowel gas & body habitus can make imaging difficult

Bowel Gas

  • Apply steady pressure to move gas

  • Jiggle the probe to move bowel aside

  • Fan to view through windows in loops of bowel

Obesity

  • Have pt lie completely flat

  • Flex pt's hips & knees to relax ab muscles

  • Lower probe frequency to improve sound wave penetration


SonoMojo Ultrasound Cheat Sheets

SonoMojo.Wordpress.com



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