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Blood vessels the aorta and its branches,

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

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Blood vessels the aorta and its branches,

  1. 1. Abdominal Ultrasound: Step by Step Berthold Block, MD Private Practice Braunschweig Germany 2nd edition 912 Illustrations Thieme Stuttgart · New York
  2. 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. 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. 4. Upper abdominal transverse scan of the aorta and vena cava. Aorta (↑), vena cava (↑ ↑).
  5. 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. 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. 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. 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. 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 (↓).
  10. 10. 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
  11. 11. 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.)
  12. 12. The End Muhammad Kashif Anwar M.Sc , RDCS, RCS kashifanwer@mail.com

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