Ch 12 Suprasternal Flashcards
What are the 2 imaging planes we use in suprasternal?
-Long axis (SSN)
-Short axis (crab view)
When would we use the short axis/crab view?
Is required in pediatrics
When are SSN images usually taken during an echo?
At the end - typically the last imaging window acquired in a standard TTE exam
How should the pt lie?
-In supine, turn head slightly to left/right
-Should lift their chin to extend their neck
-Remove pt’s pillow to extend neck even more
Where is the probe placed with SSN?
In the supraclavicular fossa (base of neck)
Where does the indicator face with SSN?
Towards pt’s left ear, approx 1 o’clock
How do we tilt/angle our probe in the SSN view?
Very steep tilt inferiorly with an anterior angulation
(think the probe is “looking into” the SSN with an anterior enough position to see the Ao arch)
List the structures seen in the SSN window?
-Ascending Ao (somewhat out of plane usually)
-Ao arch
-Descending thoracic Ao
-Brachiocephalic artery
-Left common carotid artery
-Left subclavian artery
-Right pulmonary artery (should always be seen)
(common to only have 2 of the arterial branches visible in one plane, sweep through to see others)
What are other names for the Ao arch?
-TRV arch
-Aortic isthmus
Another name for the brachiocephalic artery?
Innominate artery
List the 3 vessels coming off the Ao arch?
-Brachiocephalic/innominate artery
-Left common carotid artery
-Left subclavian artery
How can we optimize our image in the SSN?
-Rock to center image
-Heel/toe to pan b/w ascending or descending Ao
-Rotate in area b/w left ear + left shoulder to visualize all structures
-Steeper angulation allows for better visualization of descending Ao
What vessel do we always want to see when imaging the SSN?
RPA (especially with pediatrics)
What are we assessing for in the SSN?
-Ao size
-Any aneurysm or dissection
-Ao coarctation
-RPA dilation/thrombus/emboli
-Origin of vessels arising from Ao
-Sidedness of Ao
CD allows delineation of what?
Direction + magnitude of flow
What color will ascending + descending Ao flow be?
Asc: red
Desc: blue
(MUST interrogate these separately with individual + optimized CD boxes)
What color will RPA flow be?
Blue
How can we optimize our CD settings to look for areas of turbulence?
Adjust color scale + gain
Due to higher velocities, aliasing is possible. However, large areas of mosaic colors/aliasing may indicate what?
Suspicion for localized stenosis
In cases of moderate/severe Ao regurg, what will we visualize with CD?
Larger reversal in color
What are we assessing when we put color on our SSN view?
-Direction + magnitude of flow
-Any localized areas of stenosis/dilation
-Any anomalous connections
-Presence of a PDA
Why is the short axis/crab view not standardly acquired in adult echos?
-B/c not always possible to get in adults (therefore must evaluate long axis well)
-Only standard in pediatrics
What is the crab view useful in examining?
The connections of the pulmonary veins to the LA
Which PVs are seen in the crab view?
Depends on level of angulation, as different structures are visualized
(very steep angulation may be needed)
Where is the indicator pointed in the crab view?
Roughly 3 o’clock
List the structures seen in the crab view?
-RUPV (superior)
-LUPV (superior)
-RLPV (inferior)
-LLPV (inferior)
-LA
-Ao
Possibly:
-MPA
-RPA
What structure is the body of the crab + what are the legs?
Body: LA
Legs: PVs
(these are the star of the show)
Which PVs will present with red flow + which will present with blue flow into the LA?
Red: RLPV + LLPV
Blue: RUPV + LUPV
Should we increase or decrease our CD scale to allow for PV filling?
Decrease it
Areas of mosaic colors/aliasing may indicate what when imaging the crab view?
Suspicion for localized stenosis
Lack of visualization of 4 PVs would lead to suspicion of what?
Anomalous pulmonary venous return
