probe selection and machine presets for point-of-care ultrasound of the abdominal aorta

Imaging dell'aorta addominale con l'ecografia point-of-care

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.

Autore in primo piano: Utilizzo dell'ecografia point-of-care per una valutazione completa dell'aorta addominale

Un approccio alla valutazione ecografica point-of-care dell'aorta addominale

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.

Selezione della sonda e preimpostazioni della macchina per l'ecografia point-of-care dell'aorta addominale

Per eseguire una valutazione ecografica point of care dell'aorta addominale, selezionare una sonda curvilinea da 2,5 a 3,5 megahertz, che fornisce la migliore visualizzazione per la maggior parte degli adulti. In alternativa, utilizzare la sonda phased array da 1 a 5 megahertz, comunemente chiamata sonda cardiaca, che viene tipicamente utilizzata per l'ecocardiografia. Utilizzare il preset addominale sulla macchina indipendentemente dalla sonda utilizzata.Impostare la modalità su modalità B o scala di grigi bidimensionale e la profondità su 20 centimetri. Regolare la profondità una volta visualizzata l'aorta per mantenere l'aorta al centro dello schermo. Scegliere una gamma di frequenze più bassa per i pazienti con un alto indice di massa corporea per migliorare l'acquisizione delle immagini.

Research

JoVE Journal

Medicine

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

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

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

Ricerca

Medicina

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

Imaging dell'aorta addominale sul piano trasverso utilizzando l'ecografia point-of-care

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

Imaging dell'aorta addominale sul piano longitudinale e coronale utilizzando l'ecografia point-of-care