Key Learning Points
Aorta scanning top tips
- Bowel gas
- Apply steady graded pressure with the probe, and rock probe back and forth to displace gas.
- Ask the patient to take a deep breath which may help to move the bowel out of the way.
- Ask the patient to flex knees which will help relax abdominal muscles.
- Consider changing patient to left decubitus to displace bowel.
- Two hand technique for switching from short to long axis. Make sure to centre the aorta in the short axis and use one hand to keep the image centred and other to rotate the probe to obtain na long axis image.
- Alternate windows
- Often it is difficult to obtain aorta from standard views, in such cases, use the right or left side to obtain long axis views of aorta.
- From the right side – (much like the FAST view), visualize the liver, IVC and aorta.
- From the left side – visualize the spleen and adjacent aorta.
Pitfalls
There are many pitfalls in AAA scanning, predominantly by not assessing the patient clinically.
Be wary of diagnosing renal colic or musculoskeletal back pain in any patient over 60 years of age without first excluding AAA. Any patient, presenting with renal colic in this age group, should have an ultrasound scan to ensure that the aorta is non-aneurysmal.
Do not exclude an AAA unless the whole abdominal aorta and proximal iliac arteries have been visualised.
At all times think about the history and context, and ensure you are attempting to answer a legitimate question.