Abstract
Nontraumatic disorders of the aorta may be acute or chronic. Chronic disorders include aortic aneurysm, atherosclerosis, and aortitis, while acute aortic syndromes include acute aortic dissection, penetrating aortic ulcer, and aortic intramural hematoma. The aorta may be transected acutely, due to trauma, often seen after a motor vehicle accident. Congenital anomalies of the aorta most commonly include coarctation. The aorta can also become afflicted with a tumor. Transthoracic echocardiography can be utilized to evaluate the proximal to mid portion of the ascending aorta and abdominal aorta; evaluation of the aortic arch and descending thoracic aorta require more invasive (transesophageal echocardiography) or advanced imaging (CT/MRI/aortography) techniques. POCUS assessment of the aorta is thus limited to the proximal to mid ascending portion of the thoracic aorta, and the abdominal aorta. In the context of the history, physical examination, and clinical assessment, POCUS may be useful in identifying aortic abnormalities limited to these areas, particularly aneurysms and dissections, initiating additional confirmatory imaging, but cannot be considered definitive for exclusion of aortic pathologies.
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23.1 Electronic Supplementary Material
See legend for Fig. 23.2. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 9711 kb)
(a) From the PLAX position, the transducer can be slid slightly cephalad along the left sternal border edge to see more of the ascending aorta, including the mid ascending aorta, and revealing an ascending thoracic aortic aneurysm. (b) Additionally, the transducer can be moved to the right of the sternal border, at about the first to second intercostal space, to achieve the high right parasternal view and obtain an image of the mid-to distal ascending aorta. See also Fig. 23.3. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 3131 kb)
Descending thoracic aortic aneurysm seen posterior to the left atrium from the PLAX view. Note the mural thrombus within the aneurysm and the compression of the left atrium by the aneurysm. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 20650 kb)
Descending thoracic aortic aneurysm seen posterior to the left atrium from the PLAX view. Note the mural thrombus within the aneurysm and the compression of the left atrium by the aneurysm. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 3740 kb)
Normal view of the abdominal aorta visualized and screened for aneurysmal disease with the transducer held in the midline of the abdomen starting at the subcostal region and then slowly swept caudally towards the umbilicus, until the aortic bifurcation is seen (see Fig. 23.4). Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 8396 kb)
Another normal view of the abdominal aorta visualized and screened for aneurysmal disease with the transducer held in the midline of the abdomen starting at the subcostal region and then slowly swept caudally towards the umbilicus, until the aortic bifurcation is seen (see Fig. 23.4). Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 7612 kb)
Longitudinal view of patient screenings which revealed abdominal aortic aneurysms of varying complexities (true and false lumina, thrombus, debris). See also Fig. Fig. 23.4. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 8722 kb)
Transverse view of patient screenings which revealed abdominal aortic aneurysms of varying complexities (true and false lumina, thrombus, debris). See also Fig. 23.4. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 8672 kb)
Another longitudinal view of patient screenings which revealed abdominal aortic aneurysms of varying complexities (true and false lumina, thrombus, debris). See also Fig. 23.4. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 4009 kb)
Another transverse view of patient screenings which revealed abdominal aortic aneurysms of varying complexities (true and false lumina, thrombus, debris). See also Fig. 23.4. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 4086 kb)
Transthoracic echo ((a) 2-D; (b) Color flow Doppler) was quickly followed by intraoperative transesophageal echo (c, d), showing Type I aortic dissection and associated acute severe aortic regurgitation. See also Fig. 23.5. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (MPG 946 kb)
Transthoracic echo ((a) 2-D; (b) Color flow Doppler) was quickly followed by intraoperative transesophageal echo (c and d), showing Type I aortic dissection and associated acute severe aortic regurgitation. See also Fig. 23.5. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (MPG 998 kb)
Transthoracic echo ((a) 2-D; (b) Color flow Doppler) was quickly followed by intraoperative transesophageal echo (c and d), showing Type I aortic dissection and associated acute severe aortic regurgitation. See also Fig. 23.5. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 3612 kb)
Transthoracic echo ((a) 2-D; (b) Color flow Doppler) was quickly followed by intraoperative transesophageal echo (c and d), showing Type I aortic dissection and associated acute severe aortic regurgitation. See also Fig. 23.5. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 1956 kb)
Type 2 Aortic Dissection. (a) PLAX view shows linear echogenicity within the descending thoracic aorta, seen posterior to the left atrium. (b and c) Subcostal view show linear echogenicity consistent with dissection flap throughout the visualized abdominal aorta; color flow Doppler (c) clearly shows the true lumen (pulsatile color flow signal), distinct from the adjacent false lumen (absence of color flow signal). Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 3091 kb)
Type 2 Aortic Dissection. (a) PLAX view shows linear echogenicity within the descending thoracic aorta, seen posterior to the left atrium. (b and c) Subcostal view show linear echogenicity consistent with dissection flap throughout the visualized abdominal aorta; color flow Doppler (c) clearly shows the true lumen (pulsatile color flow signal), distinct from the adjacent false lumen (absence of color flow signal). Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 2255 kb)
Type 2 Aortic Dissection. (a) PLAX view shows linear echogenicity within the descending thoracic aorta, seen posterior to the left atrium. (b and c) Subcostal view show linear echogenicity consistent with dissection flap throughout the visualized abdominal aorta; color flow Doppler (c) clearly shows the true lumen (pulsatile color flow signal), distinct from the adjacent false lumen (absence of color flow signal). Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 2760 kb)
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Spittell, P.C., Bhagra, A., Mulvagh, S.L. (2018). Aorta. In: Nelson, B., Topol, E., Bhagra, A., Mulvagh, S., Narula, J. (eds) Atlas of Handheld Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-73855-0_23
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DOI: https://doi.org/10.1007/978-3-319-73855-0_23
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