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Aorta

  • Peter C. Spittell
  • Anjali Bhagra
  • Sharon L. Mulvagh
Chapter

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.

Keywords

Point-of-care cardiac ultrasound Aorta Aortic aneurysm Aortic dissection 

Supplementary material

Video 23.1

See legend for Fig. 23.2. Videos courtesy of Drs. Peter Spittell, Anjali Bhagra, and Sharon Mulvagh (AVI 9711 kb)

Video 23.2

(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)

Video 23.3a

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)

Video 23.3b

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)

Video 23.4a

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)

Video 23.4b

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)

Video 23.4c

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)

Video 23.4d

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)

Video 23.4e

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)

Video 23.4f

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)

Video 23.5a

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)

Video 23.5b

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)

Video 23.5c

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)

Video 23.5d

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)

Video 23.6a

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)

Video 23.6b

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)

Video 23.6c

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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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Peter C. Spittell
    • 1
  • Anjali Bhagra
    • 2
  • Sharon L. Mulvagh
    • 3
  1. 1.Department of Cardiovascular MedicineMayo ClinicRochesterUSA
  2. 2.Department of General Internal MedicineMayo ClinicRochesterUSA
  3. 3.Department of Medicine, Division of CardiologyDalhousie UniversityHalifaxCanada

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