Figure 53 most proximal abdominal aorta view

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Figure 5.3 Most proximal abdominal aorta view including the celiac trunk. Two variations on the anatomy are seen. Deep to the liver (and using it as a window) the celiac trunk (C), hepatic artery (H), and splenic artery (S) branches are seen. In addition the aorta (A), inferior vena cava (IVC), and vertebral body shadow (V) are visualized. 118 Diagnostic ultrasound Abdominal aorta ultrasound
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Mid aorta A transverse view of the mid aorta ( Figure 5.7 ) is obtained by moving the probe caudally along the midline while maintaining a transverse orientation (probe marker to patient’s right). This view lacks unique landmarks. Remem- ber that most AAAs are infrarenal, and this portion of the aorta should be thoroughly imaged. Distal aorta As the probe approaches the umbilicus, the distal aorta is imaged as it bifurcates ( Figure 5.8 ). In most cases, the bifurcation of the aorta is located at Figure 5.4 Standard proximal view of the abdominal aorta visualizing the aorta (A), IVC, and vertebral body shadow (V). The left renal vein (*) traverses between the aorta and the superior mesenteric artery (arrow). In this view the splenic vein (S) and a portion of the pancreas (P) and duodenum (D) are also seen. Figure 5.5 Standard proximal view of the normal aorta (with calipers measuring the diameter). The vertebral body shadow (V) is seen, and in this image the IVC (*) is flat. Diagnostic ultrasound 119 Abdominal aorta ultrasound
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the level of the umbilicus (near L4). Careful adjustment of the angle of the probe with regard to the abdominal wall will often reveal where the aorta splits into the iliac arteries. Often, a small rocking motion angling toward the feet will be all that is required to image the split. Longitudinal view Obtaining a long axis/sagittal plane view of the aorta is most easily obtained from the proximal to mid-aortic view positions. However, it should be viewed as distal as possible, given the higher rate of AAA distal to the renal arteries. Begin by locating the aorta in the short-axis/transverse plane, then slowly rotate the probe 90 degrees with the marker toward Figure 5.6 Abdominal aorta with left renal artery (arrow) visualized. Figure 5.7 Mid aorta (round) and IVC (elliptical) above the vertebral body shadow. 120 Diagnostic ultrasound Abdominal aorta ultrasound
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the patient’s head to obtain the longitudinal view ( Figure 5.9 ). Again, careful side-to-side adjustment of the angle of the probe with regard to the abdom- inal wall will ensure that the aorta’s greatest diameter is visualized ( Figures 5.10 and 5.11 ). It is also important to remember that a tubular structure (the aorta) is being imaged by a plane (the ultrasound beam). Thus, the transverse view is more accurate in terms of ensuring that the true cross-section of the aorta is visualized. When imaging longitudinally, it is easy to see how a falsely small cross-section of the aorta could be measured if the plane of the beam is just off midline ( Figure 5.11 ). The reason to image in two planes is to ensure that saccular outpouchings of the aortic wall are not missed.
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