Aorta

Extravasation

Active extravasation through endograft into false lumen. Known chronic endoleak, but CT 30 minutes prior to this study showed no active extravasation or impending rupture. Keep an open mind when reassessing your patients, and try not to anchor too much on prior results or others' opinions!

Dr. Jaffa

Aortic Root Dilation

A dilated aortic root in a patient with chest pain radiating to the back. Note that ratio or RVOT, Ao and LA is not 1:1:1. Whilst you may not always see an intimal flap, a dilated aortic root and new AR may indicate aortic dissection, subsequently confirmed on CT aortogram in this case.

Dr. Cheng

Aortic Root Dilation Color Flow

A dilated aortic root in a patient with chest pain radiating to the back. Note that ratio or RVOT, Ao and LA is not 1:1:1. Whilst you may not always see an intimal flap, a dilated aortic root and new AR may indicate aortic dissection, subsequently confirmed on CT aortogram in this case.

Dr. Peter Cheng

Mural Thrombus in AAA

74 y/o F hx stage 4 lung cancer, AAA, presented with chest pain and SOB x 1 day. POCUS shows the aorta is larger than the normal diameter of 3 cm, representing an abdominal aortic aneurysm, and measuring approximately 5.6 cm at its largest point. On cross section you are able to see a large mural thrombus with decreased diameter of blood flow through the center.

Juliana Jaramillo MD - Kings County Emergency Medicine

Abdominal Aortic Aneurysm with Thrombus

Approximately 6 cm abdominal aortic aneurysm with intramural thrombus.

Frances Russell, MD, RDMS

Assistant Professor of Emergency Medicine Division Chief, Ultrasound Fellowship Director, Ultrasound

Mural Thrombus in AAA - Doppler

74 y/o F hx stage 4 lung cancer, AAA, presented with chest pain and SOB x 1 day. POCUS shows the aorta is larger than the normal diameter of 3 cm, representing an abdominal aortic aneurysm, and measuring approximately 5.6 cm at its largest point. On cross section you are able to see a large mural thrombus with decreased diameter of blood flow through the center.

Juliana Jaramillo MD - Kings County Emergency Medicine

Aortic Root Dilation

A dilated aortic root in a patient with chest pain radiating to the back. Note that ratio or RVOT, Ao and LA is not 1:1:1. Whilst you may not always see an intimal flap, a dilated aortic root and new AR may indicate aortic dissection, subsequently confirmed on CT aortogram in this case.

Dr. Peter Cheng

Ruptured AAA

The clip above is from a patient who presented with abdominal pain and syncope. His vitals were notable for tachycardia and hypotension. The image demonstrates a very large abdominal aortic aneurysm with anterior free fluid suggestive of rupture. The patient was taken emergently to the operating room for endograft repair and did well.

Jason Tanguay, DO

Abdominal Aortic Dissection (Transverse)

Aortic dissection carries an incredibly high mortality that increases 1%/hour. POCUS can be used as a rule-in test to quickly identify this life threatening diagnosis. If a dissection is not seen on POCUS, CT angiography should still be performed because the sensitivity of POCUS is not as high as for other indications.

The spine can be used as a landmark - the echogenic stripe with shadowing in the midline. The aorta is the large vessel anterior and slightly to the right of the spine. In this image an intimal flap can be seen in the anterior third of the aorta consistent with an aortic dissection. The IVC cannot be clearly visualized in this image but would normally be left, less pulsatile, with a less echogenic vessel wall. Non-visualization of the IVC is most often due to bowel gas or compression of the abdomen with the probe.

Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al.

Pulsating Aortic Aneurysm

You may think this a dissection but it's actually an aortic aneurysm filled with thrombus, "with holes" making it a very "happy flappy." CT Confirmed.

Dr. Vincent Rietveld - Amsterdam, The Netherlands

Abdominal Aortic Aneurysm

AAA is defined as a localized balloon-like dilatation of the abdominal aorta greater than 3cm. Risk factors include male sex, increased age, and tobacco use. AAAs should be closely monitored for changes in size. Due to the risk of rupture, elective surgery is recommended when the dilatation is greater than 5-5.5cm, or it is growing in size by greater than 1cm/year. The classic triad of a ruptured AAA include pulsatile abdominal mass, hypotension and pain.

This AAA has an intramural thrombus. Some studies have claimed that POCUS has a ~100% sensitive for increased diameter. 3cm from outer wall to outer wall defines an aneurysm. Slow, graded compression is key to move the bowel out of the way in any abdominal study.

Sukh Singh, MD

Aorta Posterior Wall Rupture

63yoM witnessed collapsed. Arrived VSA with PEA rhythm. A fast look abdominal aorta POCUS showed a large abdominal aortic aneurysm with internal thrombus and rupture through the posterior wall. Note the AAA is measured from echogenic outer wall to outer wall, not the hypoechoic internal lumen that is seen pulsating. The patient was resuscitated aggressively with blood and initially survived operative repair. Unfortunately he died in the ICU several days later from multiorgan failure.

Dr. Joey Newbigging

Fetal Aorta

Pulsating fetal aorta

Marco Garrone