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

Summary

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.

Abstract

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.

Introduction

Point-of-care ultrasound (POCUS) has increased in use over the last several years and is being increasingly incorporated into various residency training programs^1,2. 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 ....

Protocol

All ultrasounds in this protocol were performed on human subjects and were conducted following the ethical standards of the University of Illinois Hospital and the Declaration of Helsinki and its revisions. The imaging was performed on the authors themselves and patients in the emergency department as part of routine education and clinical care with preceding verbal consent as is the standard for the institution. Images collected illustrate both normal anatomy and physiology as well as abnormal findings collected at the .......

Discussion

Timely diagnosis of AAA and aortic dissection is key in the treatment of these high-morbidity conditions. POCUS used in the diagnosis of AAA leads to improved outcomes and significantly decreases the time to diagnosis and operative intervention when compared with traditional imaging²⁷. POCUS has high sensitivity and specificity for AAA and high specificity for aortic dissection^12,13,19,

Materials

Name	Company	Catalog Number	Comments
M9 Ultrasound Machine	Mindray	n/a	Used to obtain all adequate and inadequate images/clips