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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 4 Abdominal Aorta Scanning Protocol 59
help to distinguish the CA (and its branches—the left gastric,
common hepatic, and splenic arteries) and just inferior to that,
the SMA.
LT
RT
4. Continue rocking and sliding the transducer inferiorly through
the middle and distal aorta to the bifurcation. Note and evaluate
the mid aorta’s lateral branches, the renal arteries. At the level
of the bifurcation, the view will change from one large, round,
echo-free structure (the aorta) to two small, round, echo-free
structures (the iliac arteries), one seen on each side of midline.
Evaluate the common iliac arteries by scanning through them
inferiorly until you lose sight of them.
RT
LT
RT
LT
Abdominal Aorta Required Images
Abdominal Aorta • Longitudinal Images
Sagittal Plane • Transabdominal Anterior Approach
NOTE: The required images are a small representation of what a sonographer visualizes during a study. Therefore, the images should provide
the interpreting physician with the most telling and technically accurate
information available.
60 PART III Abdominal Scanning Protocols
Posterior
rior
Anterior
Pancreas
mesenteric
1. Longitudinal image of the PROXIMAL AORTA (inferior to the
diaphragm and superior to the celiac trunk).
Diaphragm
Labeled: AORTA SAG PROX (Courtesy Toshiba Medical Systems Corp.)
Hepatic
artery
Cliac
trunk
Superior
Esophageal
gastric
junction
Proximal
aorta
Crus of
diaphragm
Liver
Spine
Splenic
artery
Pancreas
body
Infe
Superior
mesenteric
artery
2. Longitudinal image of the MID AORTA (inferior to the celiac
trunk and along the length of the SMA).
Anterior
Liver
Splenic
artery
Superior
Celiac
trunk
Posterior
Labeled: AORTA SAG MID (Courtesy Ultrasoundpaedia.com.)
body
Spine
Splenic
vein
Superior
artery
Inferior
Mid
aorta
CHAPTER 4 Abdominal Aorta Scanning Protocol 61
Medial
Lateral
3. Longitudinal image of the DISTAL AORTA (inferior to the SMA
and superior to the bifurcation).
Liver
Splenic
artery
Mid aorta
Labeled: AORTA SAG DISTAL
4. Longitudinal image of the AORTA BIFURCATION (common
iliac arteries).
Superior
mesenteric
artery
Distal aorta
Superior
Distal aorta
Labeled: AORTA SAG BIF or
AORTA SAG BIF LT OBL or
AORTA LT COR BIF
NOTE: To avoid moving the patient, longitudinal images of the bifurcation in the decubitus position can be taken following the axial images.
Although the coronal plane approach can be used with the patient
supine, the decubitus position is generally easier and can be helpful if
the patient has obscuring bowel gas anteriorly.
Inferior
Left common
iliac artery
Aorta
bifurcation
Right common
iliac artery
62 PART III Abdominal Scanning Protocols
Posterior
Abdominal Aorta • Axial Images
Transverse Plane • Transabdominal Anterior Approach
NOTE: The anteroposterior size of the abdominal aorta is routinely measured and documented because most ultrasound studies of the aorta are
done to rule out an aneurysm—abnormal dilatation of the weakened vessel’s wall. The biggest risk factor for rupture of an aneurysm is size. Note that
the most common location of abdominal aortic aneurysms is infrarenal.
5. Axial image of the PROXIMAL AORTA (inferior to the diaphragm
and superior to the celiac trunk) with anterior to posterior measurement (calipers outside wall to outside wall).
Anterior
Right
Liver
Proximal
aorta
Labeled: AORTA TRV PROX
6. Same image as 5 without measurement calipers.
Bowel
Left
Labeled: AORTA TRV PROX
CHAPTER 4 Abdominal Aorta Scanning Protocol 63
Posterior
7. Axial image of the MID AORTA (inferior to the celiac trunk, at the
level of the renal arteries, and along the length of the SMA) with anterior to posterior measurement (calipers outside wall to outside wall).
Pancreas
Labeled: AORTA TRV MID
8. Same image as 7 without measurement calipers.
Liver
IVC
Middle aorta
Anterior
Splenic
vein
LeftRight
Superior
mesenteric
artery
Left renal
vein
Spine
Labeled: AORTA TRV MID
64 PART III Abdominal Scanning Protocols
Posterior
ft
Left renal vein
Posterior
NOTE: If the renal arteries are not represented on the previous images, an additional
image(s) of the renal arteries should be taken here and labeled accordingly:
Anterior
Gallbladder
IVC
Right
renal
artery
Superior
mesenteric
vein
LeftRight
Pancreas
Aorta
Spine
A
Posterior
Ligamentum
teres
Right
IVC
Right
renal
artery
Anterior
Liver
Aorta
Spine
Splenic
vein
Le
Superior
mesenteric
artery
Left renal artery
B
Labeled: RT & LT RENAL ARTERIES
9. Axial image of the DISTAL AORTA (inferior to the SMA and
superior to the bifurcation) with anterior to posterior measurement
(calipers outside wall to outside wall).
Anterior
LeftRight
Distal aorta
Labeled: AORTA TRV DISTAL
CHAPTER 4 Abdominal Aorta Scanning Protocol 65
Posterior
Anterior
10. Same image as 9 without measurement calipers.
Labeled: AORTA TRV DISTAL
11. Axial image of the AORTA BIFURCATION (common iliac
arteries).
Right common
iliac artery
Labeled: AORTA TRV BIF
LeftRight
Left common
iliac artery
66 PART III Abdominal Scanning Protocols
Posterior
Anterior
mesenteric
Posterior
Pancreas
Required Images When the Abdominal Aorta is Part of Another Study
1. Longitudinal image of the PROXIMAL and MID AORTA.
Celiac
artery
Superior
Liver
Splenic
artery
Pancreas
body
Inferior
Proximal
aorta
Spine
Mid
aorta
Superior
artery
Labeled: AORTA SAG MID
2. Axial image of the MID AORTA at the level of the renal arteries.
Anterior
Liver
Splenic vein
Superior
mesenteric
artery
IVC
Middle aorta
Spine
Stomach
LeftRight
Left
renal
vein
Left
renal
artery
Labeled: AORTA TRV MID (Courtesy Ultrasoundpaedia.com.)
CHAPTER 4 Abdominal Aorta Scanning Protocol 67
Review Questions
Answers on page 628.
1. The lie of the aorta within the body is
a) mid sagittal.
b) superior to inferior.
c) transverse oblique.
d) transverse.
2. The long axis of the aorta is visualized best in a
a) sagittal or coronal scanning plane.
b) transverse scanning plane.
c) axial section.
d) right lateral decubitus position.
3. Longitudinal views of the splenic artery and common hepatic
artery are seen in a
a) sagittal or coronal scanning plane.
b) transverse scanning plane.
c) sagittal scanning plane.
d) coronal section.
4. Axial views of the SMA are seen in a
a) sagittal or coronal scanning plane.
b) transverse scanning plane.
c) sagittal scanning plane.
d) longitudinal section.
5. Longitudinal views of the renal arteries are seen in a
a) sagittal or coronal scanning plane.
b) transverse scanning plane.
c) sagittal scanning plane.
d) sagittal section.
6. The size of the aorta is normal up to
a) 3 cm.
b) 1.5 cm.
c) 2 cm.
d) 3.5 cm.
7. The proximal abdominal aorta is the portion
a) between the diaphragm and CA trunk.
b) between the diaphragm and caudate lobe of the liver.
c) just inferior to the CA trunk.
d) that ascends from the heart.
8. The mid portion of the abdominal aorta is
a) between the diaphragm and CA trunk.
b) inferior to the celiac trunk and along the length of the SMA.
c) between the CA trunk and IMA.
d) between the CA trunk and SMA trunk.
68 PART III Abdominal Scanning Protocols
9. Beginning posteriorly, and in correct order by the location in the
body, the abdominal aorta is
a) to the left of the spine, posterior to the splenic and common
hepatic arteries, the SMA, splenic vein, tail of the pancreas, left
lobe of the liver.
b) anterior and just to the left of the spine, posterior to the gastro-
esophageal junction, CA, SMA, splenic vein, body of the pancreas, portion of the stomach, left lobe of the liver.
c) anterior to the spine, posterior to the gastroesophageal junction,
splenic vein, body of the pancreas, portion of the stomach, left
lobe of the liver.
d) anterior to the spine and kidneys, posterior to the gastroesopha-
geal junction, splenic vein, body of the pancreas, portion of the
stomach, left lobe of the liver.
10. The distal abdominal aorta is the portion
a) that lies between the renal arteries and IMA.
b) inferior to the SMA trunk and superior to the bifurcation.
c) posterior to the head of the pancreas.
d) the bifurcation.
11. The aorta is posterior to all of the following except the
a) left renal vein.
b) SMA.
c) esophageal gastric junction.
d) pancreas head.
12. A(n) ______________ section of the RRA is seen ______________.
a) axial, in a transverse scanning plane between axial sections of
the superior mesenteric vein and inferior vena cava.
b) longitudinal, in a transverse scanning plane posterior to an axial
section of the inferior vena cava and longitudinal section of the
right renal vein.
c) axial, in a sagittal scanning plane between axial sections of the
SMA and aorta.
d) longitudinal, in a transverse scanning plane posterior to the
SMA.