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Aortic Aneurism with Mural Thrombus

5/25/12 - This week's IOW comes from EM PGY 3, John Weston. While evaluating a 73 yo nursing home patient who presented with a hx of CHF and a syncopal episodes, he obtained the following image. The wet sounding lungs and CHF exacerbation did not stop the ED evaluation. Bedside US of the abdomen was prompted by a limited history and surgical scars that the patient could not explain. 

Note the labeled structures in the image. Also, notice the large mural thrombus and overall diameter of the aorta - 7.72 cm! 

 

aortic anuerism

 

The video link captures the aorta in long axis and you can appreciate the abnormal contour and also visualize the thrombus.

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.  

Thank you for your continued use of bedside US.