Abdominal ultrasound step by step Chapter # 3 (Blood vessels the aorta and its branches,)

1. Abdominal
Ultrasound:
Step by Step
Berthold Block, MD
Private Practice
Braunschweig
Germany
2nd edition
912 Illustrations
Thieme
Stuttgart · New York

2. Table of ContentsTable of Contents
3 Blood Vessels: The Aorta and its Branches,
1. The Vena Cava and its Tributaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Organ Boundaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3. Locating the aorta and vena cava . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Demonstrating the aorta and vena cava in their entirety . . . . . . . . . . . .
5. Organ Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Demonstrating arterial and venous pulsations . . . . . . . . . . . . . . . . . . . . . .
7. Evaluating the vessel walls and lumina . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Identifying and defining the branches of the aorta and vena cava . . . .
9. Anatomical Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Relationship of the aorta and vena cava to the diaphragm, liver, and cardia . . . . . . . . . . .
11. Area surrounding the celiac trunk and the course of the hepatic artery, splenic artery, and
left gastric artery . . . . . . . . . . . .
12. Superior mesenteric artery, splenic vein, and renal vessels . . . . . . .
13. Iliac vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14. Lymph nodes near the retroperitoneal vessels . . . . . . . . . . . . . . . . . . . .

3. Fig. 3.1
Barriers to scanning the aorta (A) and vena cava (Vc).
The transverse colon (Ct) is a barrier to scanning, along with
the antrum (An) and duodenum (Du). Ri = costal arch.

4. Upper abdominal transverse scan
of the aorta and vena cava.
Aorta (↑), vena cava (↑ ↑).

5. Transverse scan at the level of the
bifurcation. Aortic bifurcation (↓↓),
vena cava (↑).
Transverse scan just above the
umbilicus. Details are obscured
by gas in the transverse colon.
Transverse scan between the
umbilicus and xiphoid. Aorta (↑),
vena cava (↑ ↑).

6. Longitudinal scan of the aorta (↑)
demonstrating the entry of the
aorta into the thoracic cavity.
The transducer was moved to the
right. This scan cuts the space
between the aorta and vena cava.
The transducer was moved farther
to the right, defining the vena cava
in longitudinal section (↑).

7. Longitudinal scan of the aorta (↑).
The transducer was moved to the
right. This scan cuts the space
between the aorta and vena cava.
The transducer was moved farther
to the right, showing a longitudinal
section of the vena cava (↑).

8. Diagram showing the plane of the
transverse scan (b) and the planes
of the longitudinal scans (c, d).
Upper abdominal transverse scan.
Aorta kinked to the left (↓), vena
cava (↑).
Longitudinal scan. A gap (↑) is
visible
below the superior mesenteric artery
(↓ ↓).
The transducer was moved caudad,
demonstrating the continuation of
the aorta and a posterior kink in the
vessel (↓).

9. Image the aorta in longitudinal section. Look at its thick, echogenic wall. Occasionally
a typical three-layered wall structure can be seen (Fig. 3.7). Note
how the size of its lumen does not change during pulsations or during inspiration/
expiration. Apply pressure over the aorta with the transducer and notice
that it is not compressible. The normal aorta tapers from above downward,
its diameter decreasing from approximately 2.5 cm to 2.0 cm.
Define the vena cava in longitudinal section. Notice its thin wall and the
changes in its caliber during the pulse phases. Have the subject breathe in
and out (Figs. 3.8, 3.9) and observe how the lumen narrows during inspiration.
Longitudinal scan of the aorta.
The three-layered wall structure is faintly
visible (↑). Notice the smooth outline of
the vessel wall. Fig. 3.8 Longitudinal scan of the
vena cava during inspiration (↑).
Fig. 3.9 Vena cava during
expiration (↓).

11. Aortic aneurysms tend to enlarge over time. The larger the aneurysm, the more rapid its progression. Aneurysms
less than 5 cm in diameter grow by 2–4mm each year. Cases of this kind should be scanned every three months
to evaluate size. Aneurysms with a diameter of 5 cm or more grow by up to 6mm per year. These cases should
be evaluated for surgical treatment. With aneurysms larger than 7 cm, the risk of rupture in one year is greater
than

19. Position the transducer for an upper abdominal transverse scan and identify
the liver, which at this level is interposed between the aorta and vena cava.
The cardioesophageal junction lies anterior to the aorta. The hypoechoic
musculature of the diaphragm is also seen (Fig. 3.26a). Rotate the transducer
to a longitudinal plane and scan through the region. Identify the vena cava
(Fig. 3.26b), the caudate lobe of the liver (Fig. 3.26c), the aorta, and the
gastric cardia lying anterior to it (Fig. 3.26d). (The caudate lobe is described
in detail on p. 67ff. and the gastroesophageal junction on p.166ff.)

44. The End
Muhammad Kashif Anwar
M.Sc , RDCS, RCS
kashifanwer@mail.com