L16 - Great Vessels Imaging.pdf

FRD40721 - Radiography & Medical Imaging Science ( Ultrasound Imaging ) Lecture 14 Great Vessels Imaging Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Readings • Moore, K Dalley, A 2006, Clinically Oriented Anatomy 5th Ed. Lippincott Willi...

FRD40721 - Radiography & Medical Imaging Science ( Ultrasound Imaging ) Lecture 14 Great Vessels Imaging Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Readings • Moore, K Dalley, A 2006, Clinically Oriented Anatomy 5th Ed. Lippincott Williams & Wilkins, Philadelphia • Rumack, CM Wilson, SR & Charboneau JW 2011, Diagnostic Ultrasound, Vols. 1 and 2, 3rd ed. Mosby, St Louis • Bates, JA 2011, Abdominal Ultrasound: How, Why and When, 3rd Ed. Churchill Livingstone, Edinburgh • Bhatt, S Ghazale, H & Dogra V 2007 “Sonographic Evaluation of the Abdominal Aorta” Ultrasound Clinics, pp437-453 Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae AORTA • The largest artery in the body - main arterial trunk • Arises from the left ventricle of the heart, ascends a little then bends over • Descends through the chest & abdomen, along anterior vertebral bodies • Lies immediately to left of IVC • Bifurcates at L4 or umbilicus • Dividing into two arteries, the common iliac arteries that go to the legs Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae AORTA – US Long. (Sagittal) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae AORTA – US Trans. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae AORTA Branches & Anatomy fchs.ac.ae Celiac Artery  1st branch - Celiac Artery (CA): Trifurcates into splenic artery, common hepatic artery and left gastric artery. fchs.ac.ae Celiac Artery - Longitudinal Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Celiac Artery – US Long. view Celiac A SMA Aorta Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Celiac artery - Transverse Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Celiac Artery – US Trans. view CHA Splenic A CA Aorta Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae SMA  2nd branch - Superior Mesenteric Artery (SMA): – Just inferior to CA. – Supplies small bowel, caecum, ascending colon and parts of transverse colon. fchs.ac.ae SMA - Longitudinal Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae SMA – US Long. view CA SMA Aorta Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae SMA - Transverse Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Renal Arteries 3rd branches - Renal Arteries (RA): – Right RA – Left RA – Supply kidneys, adrenals, ureters fchs.ac.ae Renal Arteries Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Renal Arteries – Trans. view Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Renal Arteries – Long. view Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IMA  4th branch - Inferior Mesenteric Artery (IMA): – Supplies left portion of transverse colon, descending and sigmoid colon and part of rectum. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IMA - Transverse IMA IVC IMA Aorta Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae AORTA – Normal Ultrasound appearance • Pulsatile • Maintains uniform shape Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta – Ultrasound Appearance • Limitations; – Bowel gas Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels • Use graded compression to displace bowel gas • Patient fasting fchs.ac.ae AORTA - Pathologies • Atheroma • Aneurysm (most common indication for ultrasound) • Thrombosis Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae AORTA - Atheroma • A fatty deposit in the inner lining (intima) of an artery • Causing obstruction to the blood flow • Incidence increases with age • Affects men more than women • Increase with diabetes • May contribute to aneurysm formation Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Atheromatous Disease Injury to endothelium Accumulation of lipids Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels Inflammation Plaque fchs.ac.ae Atheromatous Disease Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Abdominal Aortic Aneurysms (AAA) • Abnormal dilatation of an artery • Normal diameter = (Range 1.4 to 3.0 cm) • AAA < 3 cm • Risk factors: – Association with atheromatous disease – Male gender / Family history – High blood pressure – Smoking / Trauma • 30 - 60% asymptomatic, others present with abdominal, back or leg pain Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae AORTA - Complications AAA • Rupture • Internal bleeding • Thrombosis • Infection • Ischemia • Embolism Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta – AAA Measurement In this image, the Aorta is visualized in short axis. A large (>7 cm) abdominal aortic aneurysm with mural thrombus (blue arrow) and hyperechoic areas (red arrow) are shown outside the aorta, which may represent rupture. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta – AAA Measurement Ultrasound images of AAA. Cross-sectional (A) and longitudinal (B) views Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta – AAA Measurement Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta - Thrombus • Thrombus = formation or presence of a blood clot in a blood vessel. • Mural thrombus = blood clot that is attached (adhere) to the wall of a blood vessel. • Aortic thrombosis may occur after trauma. • Also as a complication of aortic plaque, specifically in smokers. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta - Thrombus Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta - Mural Thrombus • Concentric layers of thrombus often line the walls of large AAA’s Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Aorta - Mural Thrombus Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC (Inferior Vena Cava) - Anatomy • Large vein which returns (deoxygenated) blood from the lower limbs/pelvis/abdomen into right atrium. • It originates from paired CIV (common iliac veins). • It begins in the abdomen at L5 and ends in the thorax at T8. • Lies anterior and slightly to right of spine. • The normal diameter of the IVC is (1.5 - 2.5 cm). Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC - Anatomy Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC - Ultrasound • Appearance of veins – Thinner walls – Anechoic centre, thin hyperechoic walls – Valves to prevent backflow – Real-time significant variation in diameter with respiration Valve Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC – Ultrasound Long. Anatomy Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC – Ultrasound Long. Anatomy Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC – Ultrasound Trans. Anatomy Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC – Ultrasound Trans. view Aorta IVC Vertebral body Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC - Pathology  Thrombus – Most common intraluminal anomaly – Usually spreads from another vein in pelvis, lower limb, liver or kidneys – Expands the diameter of the vessel Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC - Pathology  Thrombus – Echogenicity depends on age: • Acute – hypoechoic with distended vein • Chronic – hyperechoic , may calcify – IVC tumour thrombus usually easily seen - most commonly from renal origin Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC - Thrombus Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC – Tumor Thrombus Tumor thrombus in the vena cava longitudinal Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae IVC –Thrombus Power Doppler - longitudinal view. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Retroperitoneal pathology • Lymphadenopathy – enlarged nodes • Compress the IVC Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae Questions???? Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 3: Great Vessels fchs.ac.ae