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Clinical Summary

EUS of the abdominal aorta is used to diagnose or exclude an abdominal aortic aneurysm (AAA). Although the sensitivity of abdominal ultrasound for the detection of aortic dissection is limited, the presence of an intra-aortic flap is diagnostic for aortic dissection.

Indications

  • Abdominal, back, or flank pain

  • Pulsatile abdominal mass

  • Undifferentiated hypotension

When a patient is unstable, there is no bedside test superior to an EUS of the abdominal aorta to diagnose an AAA. Early diagnosis can improve patient survival. An abdominal aortic measurement greater than 3 cm in diameter is abnormal and diagnostic of an AAA. While an AAA may rupture at any size, the risk of rupture is much greater starting with measurements greater than 5 cm. AAAs occur as both fusiform (more common) and saccular types. It is essential to image the aorta in both sagittal and transverse planes.

Views for Emergency Department Abdominal Aortic Ultrasound

  1. Transverse view

  2. Sagittal view

Equipment: Recommended Transducer for Abdominal Aortic Ultrasound

  • Convex array

Patient Position

The patient is supine.

Techniques

Transverse View

  • Place the transducer in the epigastrium with the transducer indicator oriented to the patient’s right (Fig. 24.56).

  • Identify the acoustic shadow caused by the vertebral body. The abdominal aorta is the circular, pulsating, anechoic structure anterior and slightly to the patient’s left.

  • Identify and measure the aorta at the proximal (at or above the origin of the superior mesenteric artery [SMA]), middle (near the renal arteries), and distal (immediately proximal to the bifurcation) in the anteroposterior plane (Figs. 24.57 and 24.58).

  • Identify the aorta in relation to the IVC, SMA, and splenic vein.

  • Move down the abdominal aorta to the bifurcation (approximately the level of the umbilicus) (Fig. 24.59).

FIGURE 24.56

Abdominal Aorta Transverse View. Place the transducer in the epigastrium with the transducer indicator oriented to the patient’s right. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 24.57

Abdominal Aorta: Transverse View. Short-axis view of the proximal aorta showing the celiac artery and its branches. (Ultrasound contributor: Jeremy Boyd, MD.)

FIGURE 24.58

Abdominal Aorta: Transverse View. The proximal aorta, superior mesenteric artery (SMA), and the surrounding anatomy are often compared to a mantle clock. (Ultrasound contributor: Eric Wu, MD; illustration contributor: Robinson M. Ferre, MD.)

FIGURE 24.59

Abdominal Aorta: Transverse View. Still image of the left and right iliac arteries just distal ...

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