65 yo F with PMH significant for HTN, COPD, breast ca p/w chest pain and back pain. Pt describes pain as constant, worse with exertion and associated with shortness of breath. Pt was seen by cardiologist and referred to ED for further evaluation.
Constitutional: No fever/chills,
Cardiac: +chest pain, +SOB, no palpitations
Respiratory: No cough or respiratory distress, +SOB with exertion
Abdomen: No nausea/vomiting, no diarrhea/constipation
Skin: No skin rash
Vitals: T 97.9F, BP 201/128, HR 100, RR 20, Pulse ox 89% in RA
Constitutional: anxious, well-dressed, no acute distress
Card: Normal S1 and S2, tachy, no murmurs/rubs/gallops
Resp: Lungs CTA b/l, no wheezes/rales/rhonchi
Abdomen: Soft, nontender, nondistended, normal bowel sounds
Ext: Normal ROM, no clubbing, cyanosis or edema
Neuro: Alert, anxious, oriented x 3
- What is the image in Figure A?
- What is abnormal about Figure A?
- What do you see in this sagittal view in Figure B?
- What view of the heart is in Figure C?
- What is the abnormal measurement in Figure C depicting?
1. What is the image in Figure A?
2. What is abnormal about Figure A?
The size of the distal aorta should be less than 3 cm. Significant
abdominal aneurysms (i.e., high risk of rupture) are usually greater
than or equal to 5 cm in diameter with a fusiform shape. AAAs < 4 cm
have a 2% per year risk of rupture, AAAs 4-5 cm have a 3-12% per year
risk of rupture, and AAAs > 5 cm have a 25-41% risk of rupture.
3. What do you see in this sagittal view in Figure B?
You are seeing the sagital view of the aorta, which shows a saccular
outpouching, consistent with an aneurysm. Remember that we do not
measure the aorta when imaging it longitudinally because it is easy to
get an image off midline, known as the cylinderical tangential effect. In this view, we are simply trying to
ensure that saccular outpouchings of the aortic wall are not missed.
4. What view of the heart is in Figure C?
Parasternal long, which shows the left ventricle, mitral valve, left
atrium, aortic outflow, descending thoracic aorta and right ventricle.
5. What is the abnormal measurement in Figure C depicting?
Distal thoracic aorta, which is > 3 cm.
Noble VE, MD, Nelson B, MD. Manual of Emergency and Critical Care
Ultrasound 2nd Ed. Cambridge: Cambridge University Press, 2011. Print