Diagnostic ultrasound 67 cardiac ultrasound important

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Diagnostic ultrasound 67 Cardiac ultrasound
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important for consistency of terms between clinicians. The appearance of contractility and other assessments may be altered by an incorrect or off- plane orientation. The parasternal view is often easier in obese patients, although it can be challenging in patients with significant pulmonary disease. Again, the right Figure 3.8 Orientation of probe (probe marker direction shown by green dot) and corresponding image orientation in parasternal long-axis view. Figure 3.7 Probe positioning for parasternal long-axis view. Probe marker (green dot) faces patient’s left side, pointing toward the apex. 68 Diagnostic ultrasound Cardiac ultrasound
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ventricle will be the chamber closest to the top of the screen, because it is closest to the probe ( Figure 3.9 ). Most important, the parasternal long-axis view can help distinguish pleural from pericardial effusions. Large pleural effusions can appear to surround the heart, but they will taper to the descending aorta, which can often be seen in the parasternal view. Pericardial effusions will cross anterior to the descending aorta. This is because the pleura will insert where the descending aorta travels through the thoracic cavity. The pericardium is a self-contained space that will cross the midline. In Figure 3.10 the pericar- dium is flush up against the myocardium, and there is no effusion. Left Ventricle Right Ventricle Aortic Outflow Left Atrium Mitral Valve Figure 3.9 Cartoon of parasternal long-axis view with corresponding anatomy as visualized by ultrasound. Courtesy of Dr. Manuel Colon, Hospital of the University of Puerto Rico, Carolina, PR. Figure 3.10 Normal parasternal long-axis view with no pericardial effusion, and descending thoracic aorta visible (*). Diagnostic ultrasound 69 Cardiac ultrasound
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Left parasternal short-axis view Assuming the short axis to be from the patient’s left shoulder to the right hip, the transducer probe should be placed in the third or fourth intercostal space, immediately left of the sternum ( Figure 3.11 ). If the parasternal long-axis view has already been obtained, simply rotate the transducer 90 degrees clockwise toward the patient’s right hip to find the short-axis view ( Figure 3.12 ). By sliding the probe toward the right shoulder or toward the left hip, the ultrasonographer can slice the short axis at different cross-sections – usually this view visualizes the mitral valve in cross-section ( Figure 3.13 ), but by sliding toward the right shoulder the aortic valve can be seen, or by sliding toward the left hip more focused images of the heart’s apex can be seen. This plane gives an excellent circumferential view of the left ventricle and is often used for assessment of contractility and even regional wall motion abnormalities.
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