Ultrasound Case 060

Presentation

An 80 year old woman arrests in your department. She had presented an hour earlier with back pain. You start to prepare for a subcostal view of the heart and this is what you see.


View 2 – longitudinal

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Transverse view of the abdominal aorta during CPR. A large aneurysm is present with typical lamellated intraluminal thrombus.

Image 2: Longitudinal view of the abdominal aorta in the same patient. This is an hourglass shaped aneurysm. ROSC has been achieved and slow flow through the aneurysm can be seen. The slowly moving blood looks like wisps of passing cloud. This is known as spontaneous echo contrast or smoke.


CLINICAL CORRELATION

Abdominal aortic aneurysm during cardiac arrest.

I prepare for the subcostal view in cardiac arrest during cardiac compression by initially looking at the abdominal aorta. I set the machine to record a 4 second loop. I adjust my depth and gain and then fan upward to look at the heart initially during compression and then recording during rhythm check. I have found a ruptured abdominal aortic aneurysm as the cause of arrest on several occasions.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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