Module 14 : Subcostal and Suprasternal Echo

Question 1

subcostal 4CH structures - right heart

Answer 1

• RV
• RV inferior wall
• TV
  + posterior and septal
• IVS
• RA
• IAS

Question 2

subcostal 4CH structures - left heart

Answer 2

• LV
• IVS
• MV
• LA

Question 3

which way to angle to get RVOT/PV/PA

Answer 3

• anterior

Question 4

what is best view to see IAS defect

Answer 4

• subcostal 4 chamber

- blood flows toward probe

Question 5

what can we measure better in subcostal 4 than others

Answer 5

• IVS thickness

- using axial resolution

Question 6

normal color of IAS

Answer 6

• no blood flow shunting across septum

- zoom to see holes better

Question 7

what 2 things always done on IAS picture

Answer 7

• zoom

- lower scale to 40cm/s

Question 8

SVC flow

Answer 8

• can look like IAS so make sure to put color flow on and zoom

Question 9

subcostal color IVS

Answer 9

• don’t need to lower color scale on this image

+ if lots of color on both sides

Question 10

subcostal short axis - used when

Answer 10

• no parasternal window due to disease such as COPD
• when particular structures were not seen very well in other views
• part of routine paediatric echo scan

Question 11

subcostal SAX ciews

Answer 11

• all 6 views on PSAX can be seen in subcostal

Question 12

most often used subcostal SAX views

Answer 12

• intertrial septum
• interventricular septum
• tricuspid valve
• pulmonary valve and branches

Question 13

subcostal IVC

Answer 13

• rotate probe to the 12:30
• sweep inferior from subcostal heart
• adjust depth to show IVC and RA
• probe almost vertical and slightly tilted superior
• done fore sniff test measurement

Question 14

where to measure IVC sniff test

Answer 14

• 1-2cm inferior to hepatic vein only

Question 15

abdominal aorta 2D and color

Answer 15

• pulsatile flow

- older patients walls are brighter and thicker

Question 16

abdominal aorta PW doppler

Answer 16

• triphasic wave form
• place SV as far superior in vessel as you can
• should see a little reversal

Question 17

subcostal PV/PA view

Answer 17

• really good for doppler
• best view for regurge and stenosis
• angle anterior from subcostal 4 chamber

Question 18

suprasternal notch long axis (SSN)

Answer 18

• lace probe in suprasternal nitch
• ask patient to move chin up
• may also remove pillow and put under shoulders
• angle DEEP
• probat a 1-2 position

Question 19

SSN LAX structures visible

Answer 19

• SVC
• ascending aorta
• descending aorta
• right pulmonary artery
• aortic branches
  + brachiocephalic BSA
  + left common carotid LCC
  + left subclavian LSA

Question 20

PW ascending aorta

Answer 20

• use PW unless too high of velocity

Question 21

color descending aorta

Answer 21

• put color on both ascending and descending FR as important

- redice color gain inf bleeding occurs

Question 22

alternative SSN views

Answer 22

- SSN short axis (trans)
   \+ to look at PA/AO relationship 
   \+ PA long AO short
- SSN crab view
   \+ to look at the pulmonary vein and LA
   \+ used often in peds

Question 23

SSN crab view

Answer 23

• used to see LA and 4 pulmonary veins