title: Addition of a lateral view improves adequate visualization of the abdominal aorta during clinician performed ultrasound.
abstract: OBJECTIVE
  Full visualization of the abdominal aorta using the standard midline view is often inadequate for the detection of abdominal aortic aneurysm. We evaluated whether the addition of a lateral midaxillary right upper quadrant view could improve visualization of the abdominal aorta.
  
  
  METHODS
  This was a prospective observational proof-of-concept study of patients older than 50 years undergoing abdominal computed tomographic scan for any indication in the emergency department. Ultrasounds were performed by American College of Emergency Physicians-credentialed study sonographers, and images were reviewed by an ultrasound fellowship-trained reviewer. The standard midline aortic images were obtained as well as additional lateral images from a midaxillary right upper quadrant approach. Visualization of the aorta was determined to be adequate if more than two-thirds of the abdominal aorta was visualized.
  
  
  RESULTS
  We enrolled 60 patients. Six patients were excluded due to missing data. A total of 54 patients were analyzed. The median age was 67.5, and 37% were male. The mean body mass index was 25.9 (SD, 5.8), and mean abdominal circumference was 105.3 cm (SD, 18.1). Visualization of the aorta using the midline approach was adequate in 26 (48.2%) of 54 of the patients and 32 (59.2%) of 54 of the lateral approach. Addition of a lateral view in examinations with an inadequate midline view increased adequate aortic visualization to 41 (75.9%) of 54.
  
  
  CONCLUSIONS
  Combining a lateral view to the standard midline approach improves adequate visualization of the abdominal aorta by approximately 28%. Further study is required to determine if the lateral view is equivalent for detecting abdominal aortic aneurysm.
authors.affiliation: Department of Surgery, Tiefenauspital Bern, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Studer
authors.affiliation: Department of Internal Medicine, Cardiology, University Hospital, Mainz, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Hempel
authors.affiliation: Department of Emergency Medicine, Division of Ultrasound, Brigham and Women's Hospital, Boston MA 02115, USA.
authors.forename: Shada
authors.initials: S
authors.lastname: Rouhani
authors.affiliation: Department of Emergency Medicine, Division of Ultrasound, Brigham and Women's Hospital, Boston MA 02115, USA.
authors.forename: Hana
authors.initials: H
authors.lastname: Dubsky
authors.affiliation: Department of Emergency Medicine, Division of Ultrasound, Brigham and Women's Hospital, Boston MA 02115, USA.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pivetta
authors.affiliation: Department of Emergency Medicine, Division of Ultrasound, Brigham and Women's Hospital, Boston MA 02115, USA. Electronic address: hkimberly@partners.org.
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Kimberly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D014463:Ultrasonography