Learning Objectives:

  1. Describe indications, clinical algorithm, and limitations of POCUS in the evaluation of abdominal and thoracic aortic pathology. 

  2. Perform clinical ultrasound (CUS) protocols to evaluate the abdominal and thoracic aorta, including measurement techniques.

  3. Identify relevant US anatomy, including the aorta with major branches, the inferior vena cava, and the vertebral bodies.

  4. Recognize pathologic findings and pitfalls when evaluating for abdominal and thoracic aortic aneurysm and dissection.

  5. Integrate bedside aorta ultrasound for evaluation of acute abdominal/back pain management in the emergency department


Indications:

  • The rapid evaluation of the abdominal aorta from the diaphragmatic hiatus to the aortic bifurcation for evidence of acute pathology. 

Extended Indications:

  • Abdominal aortic dissection

  • Thoracic aortic dissection

  • Presence of Intraperitoneal free fluid when abdominal aortic aneurysm (AAA) is identified 

  • Iliac, splenic, and other abdominal artery aneurysms

  • Presence of pericardial effusion, aortic regurgitation, and/or aortic root dilation (indirect signs) on bedside echocardiography when suspicion for thoracic aortic dissection is present

Required Views:

  • Proximal transverse view (at the level of the celiac artery/SMA) with measurement 

  • Proximal sagittal view (at the level of the celiac artery/SMA)

  • Distal transverse view (just before the bifurcation) with measurement

  • Distal sagittal view (just before the bifurcation) 

  • Bifurcation of aorta into common iliac arteries

ANATOMY:

How to Scan:

ACEP Sonoguide: Aorta

Five Minute Sono: Aortic Dissection

Five Minute Sono: Aortic Aneurysm

POCUS 101: Aorta Ultrasound Made Easy

Tips/Tricks/Pitfalls:

  • A small aortic diameter DOES NOT rule out rupture. Always combine the clinical picture with your US findings.

  • The aorta can be confused for the IVC. Make sure that you identify the bifurcation and branching vessels. 

  • There can be clot in the aortic wall which can make the diameter appear falsely small. Be careful to make sure that you are measuring the true outer wall to outer wall.

Pathology:

  • Abdominal Aortic Aneurysm (AAA)

  • Aortic Dissection

  • Aorta with intramural thrombus

  • AAA with graft and endoleak

  • Indirect signs of Thoracic Aortic Aneurysm

    • Pericardial Effusion

    • Dilated aortic root

Key Literature:

  1. Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study - PubMed

  2. Enhancing clinical outcomes: Point of care ultrasound in the precision diagnosis and Management of Abdominal Aortic Aneurysms in emergency medicine: A systematic review and meta-analysis - PubMed

  3. A 12-year Retrospective Cohort Study of Point-of-care Ultrasound and Aortic Dissection Risk Score in Type A Aortic Dissection - Journal of Emergency Medicine

Additional Resources:

The POCUS Atlas: Aorta

US GEL Articles

Author: Niyi Soetan, MD

Peer editing by: Kyle Ackerman, MD