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3/12/12 - This weeks IOW comes from Tox Fellow, Dr. Adam Pomerleau. While evaluating a patient with abdominal pain, he obtained the following images:

On image 1, a RUQ view capturing the gallbladder, note the shadowing from a gallbladder full of stones. Is this the primary cause of pain?  Note the secondary finding more toward the midline, what is that hypoechoic structure?


On image 2, the probe has been moved to the midline from the RUQ. Note the cross-section view of the aorta. Do you see the mural thrombus? This is a classic US image for a mural thrombus in the setting of a AAA.


On image 3 note the saccular aneurysm in addition to the mural thrombus - this is a more rare type of aneurysm compared to the more common fusiform aneurysm. 


As a reminder, to correctly image the aorta, 5 images should be obtained: 

1. Proximal Aorta – cross section with measurement of diameter
2. Mid Aorta – cross section with measurememt of diameter
3. Distal Aorta – cross section showing bifrication
4. Iliacs – cross section showing individual diameter measurements
5. Longitudinal view – capturing celiac trunk and SMA. 

The aorta is imaged in cross-section with the curvilinear probe, indicator to the right, and the diameter is measured from outer wall to outer wall. The lone longitudinal image rotates the probe 90 degrees with the indicator to the head of the patient.