Bedside Aorta Ultrasonography

imagesClinical suspicion of abdominal aortic aneurysm (AAA)

   imagesUnexplained abdominal, back, or flank pain, particularly in the older patient

   imagesUnexplained hypotension

   imagesSyncope in the setting of abdominal pain

   imagesPalpable and/or pulsatile abdominal mass


imagesNone: No contrast or radiation involved


imagesThe proximal aorta is located in the subxiphoid area

imagesThe aorta bifurcates into the iliac vessels at the level of the umbilicus

imagesOn the ultrasound display (FIGURE 12.1), first locate the vertebral body. The transverse proximal aorta is located above (anterior to) the vertebral body, to the right of the inferior vena cava (IVC), and below (posterior to) the superior mesenteric artery


imagesApply ultrasond gel on the patient’s abdomen, from the xiphoid process to just distal to the umbilicus

imagesUsing a standard 3.5- to 5.0-MHz probe with the selection marker to the patient’s right, identify the proximal aorta in the epigastric area (FIGURE 12.2)

imagesOnce the aorta is identified, scan the entire length of the vessel to the iliac bifurcation at the umbilicus


FIGURE 12.1 Transverse proximal aorta anatomy. IVC, inferior vena cava; SMA, superior mesenteric artery. (Courtesy of David Riley, MD.)


FIGURE 12.2 Ultrasound technique.

imagesMeasure the vessel diameter from outer wall to outer wall to avoid underestimation

imagesVessel measurement in the following views permits adequate screening for AAA (FIGURE 12.3):

   imagesTransverse proximal aorta

   imagesTransverse middle aorta

   imagesTransverse distal aorta

   imagesTransverse view of iliac arteries at the bifurcation

   imagesLongitudinal aorta

imagesIf an aneurysm is detected (TABLE 12.1), its relation to the renal arteries and aortic bifurcation should be documented if possible (i.e., proximal, distal)

imagesIf the aorta is not readily identified, try the following techniques:

   imagesApply gentle downward pressure with the probe to displace bowel gas

   imagesIncrease the depth of penetration on the ultrasound display

   imagesReimaging after several minutes may permit improved visualization as intestinal peristalsis displaces bowel

   imagesPlace the patient in the right or left lateral decubitus position

   imagesApproach para-midline by directing the probe toward the spine to avoid bowel gas

   imagesImage coronally through the liver

   imagesImage inferiorly to the umbilicus and direct the probe cephalad


imagesDelay in definitive surgical treatment in order to perform study. Computed tomography (CT) evaluation typically poses a greater time delay.


FIGURE 12.3 A: Longitudinal aorta. B: Transverse image of the common iliac bifurcation. (Images courtesy of David Riley, MD.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Bedside Aorta Ultrasonography
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