C14: Subcostal And Suprasternal Exam

Question 1

Which view is best to see an IAS defect?

Where is it usually located?

Answer 1

Subcostal 4CH b/c your perpendicular with you sound beam

In the membranous portion (middle)

Question 2

Which wall of the RV is seen in the subcostal 4CH view

Answer 2

Inferior wall because we are imaging from below the heart

Question 3

Where do you angle from subc. 4CH to get the RVOT/PV/PA

Answer 3

Anteriorly/towards the patients head

Question 4

In which view do we measure the RV wall?

Answer 4

Subc 4CH view b/c we using axial resolution to measure

Question 5

What pathology of the liver can make it hard to image the heart in the subcostal window

Answer 5

Cirrhosis and calcification

Question 6

What’s the best way to check for an atrial shunt when imaging in the subc 4CH view?

Answer 6

-zoom on the IAS and lower the colour scale to 40 cm/s or until you have good colour fill on both sides.

Question 7

What is a PFO, what does this stand for

Answer 7

-Patent foramen ovale

… when the foramen ovale has a flap covering it but its loose so allows blood to go from LA to RA

Question 8

If there’s a lot of flow from the Ra to the LA through the IS is it likely an ASD or an PFO?

Would we measure the opening in the IAS?

Answer 8

ASD, would let more blood flow through

Yes, using colour as a contrast

Question 9

Which vessel can be mistaken as flow across the IAS?

Answer 9

The SVC

Question 10

When would we use subcostal to do our SAX images?

Answer 10

• there’s no PSAX window due to disease like COPD
• certain structures aren’t seen well
• often used for pediatric scanning

Question 11

The Subc SAX view is often used to assess which structures?

Answer 11

• IAS
• IVS
• TV
• PV and branches

Question 12

Where’s the probe marker placed to get the subc IVC view?

Where do you sweep the beam to get this view if you’re in the subc 4CH?

Answer 12

12-12:30

Sweep inferior

Question 13

Where do you do the IVC measurement.

Do you need to do a sniff test if the IVC in collapsing with breathing

Answer 13

1-2 cm inferior to the hepatic vein

No

Question 14

What demographic of patients may have dilated IVCs but be norm>

Answer 14

Athletes and patients of ventilation

• review the IVC sizes and RAP values *

Question 15

How should the PW of the abdominal AO appear and where do you place the SV?

Answer 15

Will have a triphasic waveform

-place the Sv as superior as possible

Question 16

What do you measure when doing PW of the Ascending AO?

Answer 16

Peak velocity… outflow will be above the baseline with an empty envelop

Question 17

What are 2 alternate SSN views you may see and what are they for?

Answer 17

SSN short axis (TRANS)
+to look at PA/AO relationship (RPA will be in long axis, AO in short)

SS Crab view
+to look at Pulm veins and LA
+used often in pediatric echo

Question 18

If there’s debit in the descending AO arch where will it likely travel…. what about if its in ascending?

Answer 18

To the body/legs

Will travel to the brain

Question 19

What is a dissecting AO aneurism

Answer 19

An aneurism which causes part of the intimal wall to rip off

Question 20

Should we be scanning prox or dismally in the SSN to catch abnormalities of the AO?

Answer 20

Prox

Question 21

Should we be scanning prox or dismally in PLAX to catch abnormalities of the AO?

Answer 21

Distally