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EDUCATIONAL FORUM
Year : 2021  |  Volume : 29  |  Issue : 3  |  Page : 154-156

Ultrasound for the abdominal aorta


1 Department of Emergency, National Taiwan University Hospital, Taipei, Taiwan
2 Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
3 Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

Date of Submission12-May-2021
Date of Acceptance20-May-2021
Date of Web Publication14-Sep-2021

Correspondence Address:
Wan-Ching Lien
Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmu.jmu_129_21

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How to cite this article:
Lee AF, Liu CH, Chang PY, Lien WC. Ultrasound for the abdominal aorta. J Med Ultrasound 2021;29:154-6

How to cite this URL:
Lee AF, Liu CH, Chang PY, Lien WC. Ultrasound for the abdominal aorta. J Med Ultrasound [serial online] 2021 [cited 2021 Nov 30];29:154-6. Available from: http://www.jmuonline.org/text.asp?2021/29/3/154/326007



We report the case of a 66-year-old male whose medical history was hypertension without regular follow-up and medical control, and smoking for about 30 years (1 pack of cigarettes per day). The chief complaint at the emergency department was abdominal pain onset before 1 h and extended to the back. His vital sign on the arrival was as follows: blood pressure of 160/90 mmHg, respiratory rate of 22/min, and pulse rate of 103 beats/min. While waiting for blood drawing and results of hematology tests in the waiting area, he suddenly fainted and then complained of more aggressive abdominal pain after awaking. The vital sign in the second measure was as follows: blood pressure of 80/60 mmHg, respiratory rate of 25/min, and pulse of 110 beats/min. The patient was transferred to the critical area immediately because of shock.

As for patients with abdominal pain combining with shock, ultrasound is an important tool for diagnosis besides understanding the full medical history and complete physical examination. We can use ultrasound for the abdominal aorta as an adjunct to the primary survey.


  Scanning Targets of Ultrasound for the Abdominal Aorta Top


  • Whether the patient has abdominal aortic aneurysm? How is the diameter?
  • Whether the patient has aortic dissection?
  • Whether it has the risk of rupture?



  Selection of Probe Top


  • Abdominal probe (with 2.5–5.0 MHz convex transducer).



  Manipulation Top


Place the probe at the patient's upper abdomen and scan in the transverse [Figure 1] and longitudinal directions [Figure 2].
Figure 1: Transverse scanning of aorta

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Figure 2: Longitudinal scanning of aorta

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  Anatomical Structure of Normal Abdominal Aorta and Ultrasound Images Top


The main branches of abdominal aorta from cranial to caudal direction are celiac trunk, superior mesenteric artery, renal artery, and inferior mesenteric artery. The abdominal aorta below the inferior mesenteric artery is bifurcated into the left and right common iliac arteries, supplying the blood flow to the pelvic cavity.

  1. Transverse view: The abdominal aorta is located in the posterior abdominal cavity and anterior to the spinal cord. Spinal cord is a very important landmark in ultrasound scanning. The inferior vena cava can be seen at the right side of the patient [Figure 3]. Move the probe along the celiac trunk and the superior mesenteric artery, cranially toward caudally to the bifurcation. Renal artery and inferior mesenteric artery sometimes cannot be observed because of the patient's body type and intestinal gas
  2. Longitudinal view: After localization of the celiac trunk and the superior mesenteric artery, rotate the probe clockwise to longitudinal direction then start scanning [Figure 4].
Figure 3: Transverse view of aorta (at the celiac trunk). The anatomical structure illustrated in the figure will be observed when the probe is placed horizontally at the bottom of the diaphragm

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Figure 4: Longitudinal view of aorta. The anatomical structure illustrated in the figure can be observed in order

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  Common Diseases and the Ultrasound Images Top


The main causes of lethal abdominal pain resulted from the aorta are abdominal aortic aneurysm and aorta dissection. They must be excluded carefully.

The clinical manifestations of abdominal aortic aneurysm vary. Patients may have a sudden abdominal pain, back pain, faint, shock, or beating abdominal mass. The common risk factors include males aged more than 60 years, hypertension, smoker, and atherosclerosis.

Most abdominal aortic aneurysm is located below the renal artery. Abdominal ultrasound examines the transverse view of the abdominal aorta, and generally, the outer diameter of the abdominal aorta in transverse plane is measured. If it is larger than 3 cm, then it is abdominal aortic aneurysm. If it is larger than 5 cm, then it has a higher risk of rupture.[1]

According to the involvement of the ascending aorta, aortic dissection is categorized as Stanford type A (the dissection range involved in the ascending aorta) and type B (the dissection range not involved in the ascending aorta). Most patients with aorta dissection have tearing pain in the chest or abdomen,[2] and some of them may have local neurological signs.[3],[4],[5] Possible findings with ultrasound images included an intimal flap and ascites (caused by the raptured aorta dissection).

The ultrasound image of this case is the abdominal aortic aneurysm. However, the measured outer diameter was 3.9 cm, without peripheral effusion or ascites. The cause of the abdominal pain and shock remains to be investigated.

Patients with abdominal aorta problems, regardless of abdominal aortic aneurysm or aorta dissection, are severe and critical diseases in the abdomen that first-line physicians must pay more attention. Learning the skill of abdominal ultrasound scanning will accelerate the medical process and preserve patients' safety.

Declaration of patient consent

The authors certify that they have obtained appropriate patient consent form. In the form, the patient has given his consent for the images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vardulaki KA, Prevost TC, Walker NM, Day NE, Wilmink AB, Quick CR, et al. Growth rates and risk of rupture of abdominal aortic aneurysms. Br J Surg 1998;85:1674-80.  Back to cited text no. 1
    
2.
Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol 2015;66:350-8.  Back to cited text no. 2
    
3.
Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ. Neurological symptoms in type A aortic dissections. Stroke 2007;38:292-7.  Back to cited text no. 3
    
4.
Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J 2018;39:739-49.  Back to cited text no. 4
    
5.
Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA. Acute aortic dissection and intramural hematoma: A systematic review. JAMA 2016;316:754-63.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Scanning Targets...
Selection of Probe
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