It’s frustrating when you’re trying to see the abdominal aorta, and there is gas scatter throughout your screen in all regions except the bifurcation. I had someone on our ultrasound elective say to me one day, “Can’t we just say “Pull my finger!” or have them let one go and it get better for us?” Well, definitely would not be better for us, and it also wouldn’t help your image acquisition on the screen either – I know, bummer. But there are 3 things you can do to try to improve your image acquisition:
1. Use the larger footprint abdominal probe instead of the smaller footprint phased array cardiac probe. This covers more area of the abdomen allowing gas to spread out during your examination by pressing firmly down on the abdomen
2. As you do #1 above, and if you see gas scatter, shake the probe a bit and press down more – this can shake the gas bubbles away and allow better visualization of the aorta.
3. If you’ve done #1 and 2 above and still no go despite a valiant effort, then you can use the midaxillary approach to see a segment of the abdominal aorta in its longitudinal view (just deep to the IVC, which is just deep to the kidney and liver – so make sure to increase your depth!)
View in real-time:
At the end of the day, as I’ve said before – fluid is the lover of ultrasound and air is the enemy of ultrasound – but, fluid always wins. If there is a AAA, you’ll see it.