图 7B 经 Abhilash Koratala 博士的许可使用。

该协议中的所有超声都是在人类受试者身上进行的，并按照伊利诺伊大学医院的道德标准和赫尔辛基宣言及其修订版进行。作为常规教育和临床护理的一部分，在事先口头同意的情况下，对作者本人和急诊科的患者进行了影像学检查，这是该机构的标准。收集的图像说明了正常的解剖学和生理学，以及在伊利诺伊大学医院收集的异常发现。用于说明扫描技术的图像是在写作小组的成员身上进行的。所有超声图像均不含任何识别信息。随后的协议是使用同行评审期刊和书籍章节 10、15、16、17、18、19 的来源设计的。在本综述中，该协议将侧重于获取成人的美国图像。
1. 安全
注意：POCUS 研究可以使用非无菌手套（丁腈或乳胶）进行，具体取决于患者的过敏程度。根据临床情况和机构政策，可以采取额外的安全措施。
<ol><li>使用前检查超声系统的清洁度，并在使用后以适当的方式清洁机器和探头。清洗材料和工艺由超声设备制造商和机构标准决定。</li>
</ol>2. 探头的选择
<ol><li>对于大多数成年人来说，腹主动脉最好使用 2.5-3.5 MHz 的曲线探头进行可视化，该探头占地面积大，视野宽，呈凸波束形状。该探头通常将提供出色的分辨率和测量能力。</li>
	<li>或者，使用相控阵探头 （1-5 mHz），通常用于超声心动图，通常非正式地称为心脏探头。 注意：相控阵探头非常有用，尤其是在尝试观察近端腹主动脉通过膈裂孔离开时的情况。如果仅次于木突的空间太窄而无法容纳更宽的曲线探针，则尤其如此。相控阵探头具有矩形尺寸和三角形光束形状，视场比曲线探头更窄，但应足以实现成像目标。</li>
</ol>3. 机器预设
<ol><li>无论使用何种探头，都应使用机器上的 腹部 预设。</li>
	<li>将模式设置为 B 模式 或 二维灰度。</li>
	<li>将深度设置为 20 厘米。 注意：这通常足以可视化椎体，椎体是主动脉的重要标志。</li>
	<li>主动脉可视化后调整深度，使主动脉保持在屏幕的中间。</li>
	<li>如果由于肠气过多而难以成像，请考虑使用谐波成像来提供更好的可视化。 注意：谐波使用组织的共振特性，并创建具有更少伪影的更高分辨率图像。</li>
	<li>为体重指数高的患者选择较低的频率范围，以改善图像采集。</li>
</ol>4. 扫描技术
<ol><li>将超声波凝胶涂抹在换能器上。</li>
	<li>患者仰卧位，腹部暴露。如果患者能够耐受髋关节屈曲，将放松腹部肌肉，并可能改善图像采集。 注意：肠气会阻碍图像采集。为了改善存在肠道气体时的图像采集，操作者可以对扫描区域施加牢固的连续压力（称为分级压缩）几分钟，从而置换肠道气体。评估冠状平面的主动脉也可以避免在横平面中遇到肠气（见步骤4.3.5）。</li>
	<li>要对腹主动脉进行全面评估，请获取下面列出的图像。<ol><li>获取横平面中近端主动脉的图像。<ol><li>将换能器定向在横向平面上，指示器朝向患者右侧。确保指示器位置与屏幕上的指示器匹配（图 1A）。</li>
			<li>将换能器放置在患者剑突的远端，并施加轻微的压力，以可视化椎骨的前部及其高回声阴影投射弓（图1B）。 注意：肝脏将出现在屏幕的左上角，并充当声学窗口。主动脉将出现在椎体正上方，作为屏幕右侧的消声圈，对应于患者的左侧。下腔静脉 （IVC） 位于屏幕的左侧，对应于患者的右侧。IVC 的壁比主动脉壁薄，即使在轻压下也经常可折叠。</li>
			<li>向尾部滑动换能器，直到看到腹腔躯干。腹腔躯干较短，迅速分叉成肝动脉和脾动脉。当两条动脉一起观察时，这称为 海鸥征 （图2）。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
			<li>向尾部滑动换能器以遇到肠系膜上动脉 （SMA），该动脉从前主动脉脱落并很快向下移动，通常沿着与主动脉平行的路径。脾静脉在SMA前方，左肾静脉在SMA和主动脉之间（图3）。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
			<li>通过优化该位置主动脉的实时图像，然后按下系统的 冻结 按钮，测量肾上主动脉的 AP 直径。</li>
			<li>按 卡尺 或 测量 并将系统的轨迹球或触摸板移动到前壁的外边缘，即外膜，然后单击 选择。</li>
			<li>再次将轨迹球或触摸板移动到后壁的外边缘，然后单击 “选择”。等待系统生成测量值（图 4）。</li>
			<li>通过单击系统上保存静止图像的按钮，将此图像保存为包含测量值的静止图像。 注意：主动脉 AP 直径的法线上限为 3.0 厘米。任何测量值>3 cm 都被认为是动脉瘤15、16、20、21。</li>
		</ol></li>
		<li>对横平面中的远端主动脉进行成像。 注意：远端主动脉占腹主动脉的三分之二，从肾动脉的远端开始。大多数 AAA 发生在该远端节段。<ol><li>与近端主动脉一样，继续在横向平面上扫描，通过分叉观察整个主动脉。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
			<li>当远端主动脉的实时图像得到优化时，测量肾下主动脉的 AP 直径。</li>
			<li>按 卡尺 或 测量 并将系统的轨迹球或触摸板移动到前壁的外边缘，即外膜，然后单击 选择。</li>
			<li>再次将轨迹球或触摸板移动到后壁的外边缘，然后单击 “选择”。等待系统生成测量值。</li>
			<li>通过单击系统上保存静止图像的按钮，将此图像保存为包含测量值的静止图像。 注意：鉴于远端主动脉的长度更长且动脉瘤扩张的可能性增加，因此至少对远端主动脉进行两次测量是谨慎的。</li>
			<li>当腹主动脉经腹部尾部时调整深度，因为它变得更加浅表并略微变细。</li>
		</ol></li>
		<li>获取主动脉分叉到左右髂动脉的视频剪辑（视频 1 - 参见补充文件 1：补充图 S1）。<ol><li>继续向尾部扫描，根据需要调整深度以保持主动脉和椎体在屏幕中间。</li>
			<li>通过主动脉分叉扫描到左髂动脉和右髂动脉。</li>
			<li>在扫描分岔时捕获图像。</li>
		</ol></li>
		<li>在纵向平面上获取主动脉的图像和视频剪辑。<ol><li>将探头放在近端腹部，从剑突下区域重新开始。</li>
			<li>通常更容易从横向平面开始，指示器朝向患者右侧。优化主动脉的横视图后，顺时针旋转探头，沿着主动脉旋转，因为图像在屏幕上变得纵向并且指示器指向患者的头部（图 5A）。</li>
			<li>在扫描尾部检查动脉瘤扩张时获取图像。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。 注意：在长轴视图中，腹腔主干和SMA很容易从前主动脉突出（图5B）。建议不要测量主动脉在纵轴上的直径。如果超声束与主动脉相切相交，而不是在其中线，则测量值将错误地小于通过最大 AP 直径的测量值（图 6）。</li>
		</ol></li>
		<li>可选：获取冠状平面中主动脉的纵向视图。如果难以在横向或纵向平面上获取视图，则此视图非常有用。<ol><li>从患者右侧腋窝中线冠状面上的换能器开始，指示器指向颅骨（图7A）。</li>
			<li>如果患者可以，将他们置于左侧卧位，以便更好地获取图像。</li>
			<li>扫描冠状平面中的主动脉。如果对两条血管都进行成像，主动脉将在 IVC 深处可视化（图 7B）。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
		</ol></li>
	</ol></li>
</ol>

使用床旁超声对腹主动脉进行成像

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L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Emergency+department+ultrasound+scanning+for+abdominal+aortic+aneurysm:+accessible,+accurate,+and+advantageous.">Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate, and advantageous.</a> Annals of Emergency Medicine. 36 (3), 219-223 (2000).</li><li>Cazes, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Emergency+ultrasound:+a+prospective+study+on+sufficient+adequate+training+for+military+doctors.">Emergency ultrasound: a prospective study on sufficient adequate training for military doctors.</a> Diagnostic and Interventional Imaging. 94 (11), 1109-1115 (2013).</li><li>Bonnafy, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+measurement+of+the+abdominal+aortic+diameter+by+novice+operators+using+a+pocket-sized+ultrasound+system.">Reliability of the measurement of the abdominal aortic diameter by novice operators using a pocket-sized ultrasound system.</a> Archives of Cardiovascular Diseases. 106 (12), 644-650 (2013).</li><li>Baliga, R. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+imaging+in+aortic+dissection+and+related+syndromes.">The role of imaging in aortic dissection and related syndromes.</a> Journal of the American College of Cardiology: Cardiovascular Imaging. 7 (4), 406-424 (2014).</li><li>Lewiss, R. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CORD-AEUS:+consensus+document+for+the+emergency+ultrasound+milestone+project.">CORD-AEUS: consensus document for the emergency ultrasound milestone project.</a> Academic Emergency Medicine. 20 (7), 740-745 (2013).</li></ol>

作者没有利益冲突需要声明。

及时诊断 AAA 和主动脉夹层是治疗这些高发病率疾病的关键。与传统影像学相比，用于 AAA 诊断的 POCUS 可改善结果并显着缩短诊断和手术干预的时间27。POCUS 对 AAA 具有高敏感性和特异性，对主动脉夹层具有高特异性12、13、19、21、28、29...

床旁超声 （POCUS） 的使用在过去几年中有所增加，并越来越多地被纳入各种住院医师培训计划 1,2。POCUS在急诊科和重症监护室等重症监护领域具有很大的实用性，特别是有助于快速诊断危及生命的腹腔内紧急情况，如急性主动脉夹层，以及腹主动脉瘤，特别是那些有破裂风险的动脉瘤和那些已经破裂到腹膜的动脉瘤。
AAA 破裂和急性主动脉夹层与高死亡率相关。主动脉瘤破裂的死亡率为 67% 至 94%3,4。急性夹层后，A 型主动脉夹层的死亡率以每小时 1% 的速度增加，B 型主动脉夹层的死亡率在 30 天时为 10% 至 25%5。孤立的腹主动脉夹层很少见，仅占所有主动脉夹层的0.2%-4%6,7,8,9,10。由于大多数腹主动脉夹层是胸主动脉夹层的延伸，因此评估腹主动脉的夹层证据可能有助于胸主动脉夹层的诊断11。
计算机断层扫描与血管造影 （CTA） 是腹主动脉相关影像学病理学的金标准;但是，它有几个缺点。这可能很耗时，尤其是在不稳定的患者中，并且需要技术人员执行，并需要放射科医生或血管外科医生来解释图像。CTA 使用电离辐射，需要使用静脉注射造影剂以最佳方式检测病理学。此外，CTA 的性能要求潜在不稳定的患者离开重症监护区。相比之下，POCUS 是非侵入性的、具有成本效益的，并且缺乏 CT 所需的电离辐射和造影剂。它也可以由同一个人实时执行和解释，不需要患者离开监测区域。
Rubano 等人对急诊科 POCUS 诊断 AAA 的系统评价显示，其敏感性为 99%，特异性为 98%，阳性似然比为 99，阴性似然比为 0.0112。这项汇总分析评估了不同操作员组的测试特征，包括接受过广泛 POCUS 培训的住院医师和主治医师。
腹主动脉夹层 POCUS 评估的测试特征与 AAA 不同，并且可能因夹层的起源而异。内膜瓣分离真腔和假腔的超声检查结果对主动脉夹层的敏感性为 67%-79%，特异性为 99%-100%13,14。由于在腹部发现的大多数主动脉夹层是胸主动脉夹层的延伸，因此可以进行心脏和肺部的额外 POCUS 应用以评估心包积液、主动脉根部扩张和左胸腔积液，但不是本文的重点13。
最后，需要注意的是，美国预防服务工作组为对 65-75 岁曾经吸烟的男性进行一次性 AAA 超声筛查提供了 B 级建议。这与初级保健环境特别相关。
本综述将描述POCUS在腹主动脉床旁评估中表现的分步方案，特别是评估AAA和腹主动脉夹层。该协议假定诊断超声的基本知识，包括物理学、仪器，以及腹主动脉和主要分支动脉的解剖学和病理状态的医学知识。建议读者参考其他来源以获取先决条件知识。

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	<tbody>
		<tr>
			<td>M9 Ultrasound Machine&#160;</td>
			<td>Mindray&#160;</td>
			<td>n/a</td>
			<td>Used to obtain all adequate and inadequate images/clips</td>
		</tr>
	</tbody>
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an approach to point-of-care ultrasound evaluation of the abdominal aorta

腹主动脉疾病，包括动脉瘤和夹层，具有潜在的高发病率和死亡率。虽然计算机断层扫描 （CT） 是目前腹主动脉成像的金标准，但获得 CT 的过程可能很耗时，需要使用静脉注射造影剂，并且涉及暴露于电离辐射。床旁超声（POCUS）可以在床旁进行，对腹主动脉瘤的诊断具有极好的敏感性和特异性，对腹主动脉夹层的诊断具有极好的特异性。此外，POCUS 是非侵入性的、具有成本效益的、没有电离辐射的，不需要静脉注射造影剂，并且可以在不将患者从重症监护区带走的情况下进行。腹主动脉瘤 （AAA） 的筛查也可以在初级保健机构进行。 
本文将回顾腹主动脉 POCUS 的评估方法，以评估此类关键病理学。在本文中，我们将回顾腹主动脉的超声解剖结构以及超声探头的选择、POCUS 图像采集的描述以及使用 POCUS 帮助诊断可能危及生命的腹主动脉病变的一些细节和陷阱。

Point-of-care ultrasound (POCUS) has increased in use over the last several years and is being increasingly incorporated into various residency training programs1,2. POCUS has great utility in critical care areas such as the emergency department and the intensive care unit, specifically to aid in the rapid diagnosis of life-threatening intraabdominal emergencies such as acute aortic dissection, as well as abdominal aortic aneurysms, especially those at risk for rupture and those that have ruptured into the peritoneum.
AAA rupture and acute aortic dissection are associated with high mortality. The mortality of ruptured aortic aneurysms ranges from 67% to 94%3,4. The mortality associated with type A aortic dissection increases at a rate of 1% per hour after acute dissection and the mortality of type B aortic dissection ranges from 10% to 25% at 30 days5. Abdominal aortic dissection in isolation is rare and accounts for only 0.2% to 4% of all aortic dissections6,7,8,9,10. Since most abdominal aortic dissections occur as an extension of thoracic aortic dissections, evaluation of the abdominal aorta for evidence of dissection may aid in the diagnosis of thoracic aortic dissection11.
Computed tomography with angiography (CTA) is the gold standard for imaging pathology associated with the abdominal aorta; however, it has several drawbacks. It may be time-consuming, especially in an unstable patient, and requires a technician to perform and a radiologist or vascular surgeon to interpret the images. CTA uses ionizing radiation and requires the use of intravenous contrast dye for optimal detection of pathology. Furthermore, the performance of CTA requires potentially unstable patients to leave the critical care area. In contrast, POCUS is non-invasive, cost-effective, and lacks the ionizing radiation and contrast dye that CT requires. It can also be performed and interpreted by the same individual in real time and does not require the patient to leave the monitored area.
A systematic review of emergency department POCUS for diagnosing AAA by Rubano et al. revealed a sensitivity of 99% and specificity of 98%, with a positive likelihood ratio of 99 and a negative likelihood ratio of 0.0112. This pooled analysis evaluated the test characteristics over a varied group of operators, including resident and attending physicians with a wide range of training in POCUS.
The test characteristics for the POCUS evaluation of abdominal aortic dissection are different from those of AAA and may vary depending on the origin of the dissection. Sonographic findings of an intimal flap separating the true and false lumens have a sensitivity of 67%-79% and a specificity of 99%-100% for aortic dissection13,14. As most aortic dissections found in the abdomen are an extension of a thoracic aortic dissection, additional POCUS applications of the heart and lungs to evaluate for pericardial effusion, aortic root dilatation, and left pleural effusion may be performed, but will not be the focus of this paper13.
Finally, it is important to note that the United States Preventative Services task force provides a Grade B recommendation for a one-time ultrasound screening for AAA in men aged 65-75 who have ever smoked. This is particularly relevant to the primary care setting.
This review will describe a step-by-step protocol for the performance of POCUS in the bedside evaluation of the abdominal aorta, specifically to evaluate for AAA and abdominal aortic dissection. This protocol assumes a basic knowledge of diagnostic ultrasound, including physics, instrumentation, as well as medical knowledge of anatomy and pathologic states of the abdominal aorta and major branching arteries. Readers are advised to refer to other sources for prerequisite knowledge.

作者聚焦：使用床旁超声全面评估腹主动脉

腹主动脉床旁超声评估方法

We seek to demonstrate the use of point-of-care ultrasound or POCUS to evaluate the anatomy and pathology of the abdominal aorta. POCUS has excellent sensitivity and specificity for the evaluation of abdominal aortic aneurysm, and excellent specificity for the evaluation of abdominal aortic dissection. Some of the challenges include ensuring POCUS users have adequate training and ensuring they can identify pathology and artifacts with accuracy.This protocol is comprehensive and can be performed and interpreted by the same individual in less than five minutes. This is faster than computed tomography angiography, especially when the patient is critically ill and not stable enough to leave the critical care area for an imaging test.

充分的检查 从腹主动脉超声中获得准确结果的最大挑战之一是缺乏对测量的共识。如协议步骤 4.3.1.10 所述，腹主动脉的任何直径大于 3 cm 都被认为是动脉瘤15、16、22、23。然而，用于测量主动脉直径的方法存在很大差异，并且对于测量腹主动脉尚无国际共识。目前使用的有三种方法：?...

Watch this Scientific Journal Video about An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta at JoVE.com

该方案回顾了使用床旁超声对腹主动脉进行成像的步骤。我们讨论了图像采集、成像陷阱和伪影的故障排除，以及危及生命的腹主动脉病变的识别。

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography ...

我们试图展示使用床旁超声或 POCUS 来评估腹主动脉的解剖结构和病理学。POCUS对腹主动脉瘤的评估具有优异的敏感性和特异性，对腹主动脉夹层的评估具有优异的特异性。其中一些挑战包括确保 POCUS 用户接受足够的培训，并确保他们能够准确地识别病理和伪影。该协议是全面的，可以由同一个人在不到五分钟的时间内执行和解释。这比计算机断层扫描血管造影更快，特别是当患者病情危重且病情不稳定，无法离开重症监护区进行影像学检查时。

an-approach-to-point-care-ultrasound-evaluation-abdominal

Research

JoVE Journal

Medicine

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta

1.5K 次观看.  University of Illinois Hospital. 我们试图展示使用床旁超声或 POCUS 来评估腹主动脉的解剖结构和病理学。POCUS对腹主动脉瘤的评估具有优异的敏感性和特异性，对腹主动脉夹层的评估具有优异的特异性。其中一些挑战包括确保 POCUS 用户接受足够的培训，并确保他们能够准确地识别病理和伪影。该协议是全面的，可以由同一个人在不到五分钟的时间内执行和解释。这比计算机断层扫描血管造影更快，特...

视频: 作者聚焦：使用床旁超声全面评估腹主动脉

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography (CT) is the current gold standard to image the abdominal aorta, the process of obtaining a CT may be time-consuming, requires the use of intravenous contrast dye, and involves exposure to ionizing radiation. Point-of-care Ultrasound (POCUS) can be performed at the bedside and has excellent sensitivity and specificity for the diagnosis of abdominal aortic aneurysm and excellent specificity for the diagnosis of abdominal aortic dissection. Additionally, POCUS is non-invasive, cost-effective, lacks ionizing radiation, requires no intravenous contrast dye, and can be performed without taking the patient from a critical care area. Screening for abdominal aortic aneurysm (AAA) can be done in primary care settings as well. 
This article will review the approach to POCUS of the abdominal aorta to evaluate such critical pathology. In this paper, we will review the sonographic anatomy of the abdominal aorta as well as the choice of the ultrasound probe, description of POCUS image acquisition, and some pearls and pitfalls of using POCUS to aid in the diagnosis of potentially life-threatening abdominal aortic pathology.

This protocol reviews the steps to image the abdominal aorta with point-of-care ultrasound. We discuss image acquisition, troubleshooting imaging pitfalls and artifacts, and the recognition of life-threatening abdominal aortic pathology.

科研

医学

Probe Selection and Machine Presets for Point-of-Care Ultrasound of the Abdominal Aorta

To perform a point of care ultrasound evaluation of the abdominal aorta, select a 2.5 to 3.5 megahertz curvilinear probe, which provides the best visualization for most adults. Alternatively, use the phased array probe of 1 to 5 megahertz, commonly called cardiac probe, which is typically used for echocardiography. Use the abdominal preset on the machine regardless of the probe used.Set the mode to B mode or two-dimensional gray scale and the depth to 20 centimeters. Adjust the depth once the aorta is visualized to keep the aorta in the midfield of the screen. Choose a lower frequency range for patients with a high body mass index to improve image acquisition.

腹主动脉床旁超声的探头选择和机器预设

Imaging the Abdominal Aorta in the Transverse Plane Using Point-of-Care Ultrasound

To begin scanning, position the patient's supine with the abdomen exposed. Hip flexion, if tolerated by the patient, relaxes the abdominal muscles and may improve image acquisition. Apply ultrasound gel to the transducer.Orient the transducer and the transverse plane with the indicator toward the patient's right. Ensure that the indicator position matches the one displayed on the screen. Place the transducer just distal to the patient's xiphoid process and apply light pressure to visualize the anterior aspect of the vertebra with its hyperechoic shadow casting arch.Slide the transducer coddly until the celiac trunk is visualized. The celiac trunk is short and quickly bifurcates into the hepatic artery and splenic artery, which together form the seagull sign. Capture these images for later review by clicking the button on the system that records clips.Slide the transducer coddly to view the superior mesenteric artery or SMA. Coming off the anterior aorta, SMA follows a path parallel to the aorta to course inferiorly. The splenic vein courses anterior to the SMA and the left renal vein courses between the SMA and the aorta.Measure the AP diameter of the suprarenal aorta by optimizing a live image of the aorta in this location, and then pressing the system's freeze button. Press caliper or measure and move the track ball or touch pad of the system to the outer edge of the anterior wall, the adventitia and click select. Next, move the track ball or touch pad again to the outer edge of the posterior wall and click select.Wait for the system to generate a measurement. Click the button on the system that saves still images to save this image as a still image containing the measurement. Continue scanning in a transverse plane to visualize the entirety of the aorta through the bifurcation and capture the images.When a live image of the distal aorta is optimized, measure the AP diameter of the infrarenal aorta. Press caliper or measure and move the track ball or touch pad of the system to the outer edge of the anterior wall, the adventitia and click select. Move the track ball or touch pad again to the outer edge of the posterior wall and click select.Wait for the system to generate a measurement. Save the still image as demonstrated previously. Adjust the depth as the abdominal aorta courses coddly through the abdomen becoming more superficial and tapering slightly.Continue scanning coddly through the aortic bifurcation into the left and right iliac arteries. Adjusting the depth to maintain the aorta in vertebral body in the middle of the screen. Capture images while scanning through the bifurcation.When imaging the abdominal aorta in the transverse plane, an aorta measuring greater than 3 centimeters was considered aneurysmal. Such aneurysms also showed the presence of a hematoma filling most of the lumen. The presence of an intimal flap within the lumen of the aorta indicated aortic dissection.Depending on the chronicity of the dissection, the flap was either thin and moved with the pulsations of the aorta or thickened and had an adjacent hematoma. An acute thoracic aortic dissection was found to extend through the abdominal aorta and into the right iliac artery.

使用床旁超声对横平面腹主动脉进行成像

Imaging the Abdominal Aorta in the Longitudinal and Coronal Plane Using Point-of-Care Ultrasound

To begin scanning, position the patient's supine with the abdomen exposed. Hip flexion, if tolerated by the patient, relaxes the abdominal muscles and may improve image acquisition. Apply ultrasound gel to the transducer.Place the transducer transversely in the proximal abdomen, and the transverse plane, with the indicator toward the patient's right. Ensure that the indicator position matches the one displayed on the screen. Starting in the subxiphoid area, scan to obtain a transverse view of the aorta.Once the transverse view of the aorta is optimized, rotate the probe clockwise with the indicator pointing towards the patient's head. Following the aorta as the image becomes longitudinal on the screen. Acquire images while scanning caudally, examining for aneurysmal dilations, and save these images for later review by clicking the button on the system that records clip.To obtain a longitudinal view of the aorta in the coronal plane, if possible, position the patient in the left lateral decubitus position for better image acquisition. Place the transducer in the coronal plane at the mid axillary line on the patient's right with the indicator pointing cranially. Scan the aorta in the coronal plane.The aorta will be visualized deep into the IVC if both vessels are imaged. The abdominal aortic pseudo thrombus was a reverberation artifact resulting from the reflection of the ultrasound beam between the anterior and posterior walls of the SMA.