21 Ultrasound Techniques for the Aorta
Lo Zhen Zhen
Ultrasound of the aorta involves scanning at several places to get the best view of the overall aorta regions.
The techniques of getting adequate views of the aorta are described in the tables below
| Aspect | Details |
| Segments | Ascending aorta, aortic arch, descending thoracic aorta, abdominal aorta |
| Branches | Coronary arteries, brachiocephalic trunk, left common carotid artery, left subclavian artery |
| Indications | Suspected Aortic Aneurysm, Aortic Dissection, Trauma |
| Landmark Summary | Ascending Aorta (parasternal long-axis view), Aortic Arch (suprasternal notch view), Abdominal Aorta (subxiphoid/transabdominal) |
| Probe Selection | Phased Array Probe (thoracic aorta), Curvilinear Probe (abdominal aorta) |
| Structures Identified | Aortic Wall, Lumen, Branches |
| Normal Findings | Uniform diameter, no wall thickening, or intraluminal masses |
| Pathological Findings | Aneurysm, Dissection, Thrombus |
| Image Windows/Techniques | Transducer Placement, Depth and Gain Adjustments |
| Sonographic Findings | Aneurysm (aortic diameter measurement), Dissection (intimal flap identification), Wall Abnormalities (thickness/irregularities) |
| Pathological Sonographic Findings | AAA, Thoracic Aortic Aneurysm, Dissection (presence of flap separating lumens) |
| Aspect | Transverse View | Longitudinal View |
| Probe Placement | Perpendicular to the abdomen, above the umbilicus, orientation marker to the patient’s right | Parallel to the aorta, with orientation marker pointing cephalad (towards the patient’s head) |
| Objective | Visualize the aorta in a cross-sectional view | Assess the aorta in its long axis |
| Technique | Sweeping from xiphoid to umbilicus, adjusting depth and gain | Slide and tilt along the midline, maintaining longitudinal view, with similar depth and gain adjustments |
| Segmental Assessment | Proximal Segment (below diaphragm to SMA origin): Evaluate for proximal aneurysms and dissection. Middle Segment (SMA to renal arteries): Check for aneurysms, atherosclerotic changes, and renal artery origins. Distal Segment (renal arteries to bifurcation): Assess for infrarenal aneurysms and bifurcation. | Similar to transverse, with emphasis on the length and continuity of the aorta. |
| Image Criteria | Measure outer-to-outer wall diameter and observe wall characteristics, lumen appearance, and pathology detection (aneurysms, dissections) | Similar criteria as in transverse view, focusing on longitudinal diameter, wall and lumen evaluation |
Other techniques, such as colour Doppler, can be used in addition to these basic views to provide a more complete blood flow assessment and identify any vascular anomalies. Colour Doppler can measure flow dynamics and distinguish between true and false lumens in aortic dissection cases.
The interactive video above is a simple tutorial on how to carry out Abdominal Aorta Scan. Adapted from “Video 17 Tutorial on ultrasound for abdominal aortic aneurysm” by International Emergency Medicine Education Project is licensed under CC BY 4.0
