Bsic Ultrsound Views 2 Kenneth D. Horton K.D. Horton Echo/Vsculr Lortory, Intermountin Medicl Center, Murry, UT, USA e-mil: kd.horton@comcst.net T.P. Arhm (ed.), Cse Bsed Echocrdiogrphy, DOI: 10.1007/978-1-84996-151-6_2, Springer-Verlg London Limited 2011 13
14 K.D. Horton Fig. 2.1 Echocrdiogrphic windows. When performing n echocrdiogrm, the trnsducer is plced in multiple res of the chest. These res re commonly referred to s windows. The most common echo windows re: () the left prsternl window, () the picl window, (c) the sucostl window, nd (d) the suprsternl notch. In certin circumstnces, imging from nonstndrd windows is required. Some of the nonstndrd windows include the right prsternl window nd the mid-clviculr window. In some cses, imging my need to e performed from ny re of the chest from where n imge cn e otined (Adpted from Servier Medicl Art, www. servier.com, with permission) c d Fig. 2.2 Echocrdiogrphic views. From ech window, the trnsducer is mnipulted to otin multiple views of the hert. The different views re otined y rotting nd/or tilting the trnsducer without ctully moving it to new window
2 Bsic Ultrsound Views Fig. 2.3 The prsternl window. The prsternl long xis (PLAX) view is otined y plcing the trnsducer in the three to four left intercostl spces close to the sternum with the en oriented towrd the ptient s right shoulder. This orienttion slices through the hert on long xis from se to pex (Adpted from Servier Medicl Art, www. servier.com, with permission) Fig. 2.4 The prsternl window. The prsternl long xis (PLAX) view is otined y plcing the trnsducer in the third to fourth left intercostl spce close to the sternum with the en oriented towrd the ptient s right shoulder. This orienttion slices through the hert on long xis from se to pex Fig. 2.5 Prsternl long xis color flow imge. Color flow Doppler imging is used to ssess the vlves for regurgittion. Pictured here is systolic still frme demonstrting regurgittion of lood flow ck through the mitrl vlve into the left trium 15
16 K.D. Horton Fig. 2.6 Right ventriculr inflow (RVIF) view. The RVIF view is otined y tilting the trnsducer towrd the left shoulder so the ultrsound em moves nterior in the chest slicing through the right hert. () This view is used to ssess the right ventricle, tricuspid vlve, nd right trium. () Color flow nd spectrl Doppler re used to ssess the vlve for tricuspid regurgittion c d Fig. 2.7 Prsternl short xis (PSAX) view. The PSAX view is otined y remining in the prsternl window nd rotting the trnsducer clockwise pproximtely 90. Sweeping the trnsducer from se to pex results in: () the sl level view, () the mitrl level view, (c) the ppillry level view, nd (d) the picl level view. In the sl nd mitrl level view, color flow Doppler cn e used to ssess the vlves for regurgittion
2 Bsic Ultrsound Views 17 Fig. 2.8 Apicl views. The picl window is usully found in the left lterl portion of the chest t the pex of the hert. This cn sometimes e locted y plcing your hnd lightly in the re of the pex nd feeling for the point of mximl intensity (PMI). The PMI will serve s your strting point; however, smll djustments will need to e mde to the trnsducer loction to mximlly optimize your imge (Adpted from Servier Medicl Art, www.servier. com, with permission) Fig. 2.9 Apicl 4 Chmer (4C) view. All four crdic chmers re visulized in the 4C view long with the mitrl nd tricuspid vlves. Ventriculr nd tril size cn e ssessed using 2D echo. Color flow nd spectrl Doppler cn e used to ssess for vlvulr regurgittion nd stenosis. Left ventriculr distolic function cn e ssessed using pulsed wve Doppler of the mitrl vlve nd pulmonry veins. In this view, the right ventriculr freewll, interventriculr septum, nd left lterl wll cn e ssessed for systolic motion
18 K.D. Horton Fig. 2.10 Apicl 5 Chmer (5C) view. () The 5C view is otined y tilting the trnsducer slightly so the em moves nterior in the chest slicing through the left ventriculr outflow trck (LVOT) nd ortic vlve. () Utilizing spectrl Doppler, the outflow velocity cn e mesured. In this exmple, the high-velocity flow pttern indictes ortic stenosis. The ortic vlve re cn e clculted y integrting dt from the 2D imges nd Doppler trcings Fig. 2.11 Apicl 2 Chmer (2C) view. The 2C view is otined y strting t the 4C view nd rotting the trnsducer clockwise pproximtely 90. In the 2C view, the left ventricle, mitrl vlve, nd left trium cn e seen. The inferior nd nterior wlls of the left ventricle cn e ssessed for systolic function. Using color flow nd spectrl Doppler, the mitrl vlve cn e ssessed for regurgittion nd stenosis Fig. 2.12 Apicl 3 Chmer (3C) or long xis view. The picl 3C view is lso known s the picl long xis view. Structures seen in the 3C view re the sme s the prsternl long xis view. The 3C view is utilized to ssess chmer size nd function s well s ortic nd mitrl vlve function
19 2 Bsic Ultrsound Views Fig. 2.13 The sucostl window. Sucostl views re otined y positioning the ptient flt on their ck nd plcing the trnsducer just elow the xiphoid process. Asking the ptient to end their knees my help relx the stomch muscles. Hving the ptient tke deep reth often moves the lungs out of the wy nd results in etter imges (Adpted from Servier Medicl Art, www.servier. com, with permission) Fig. 2.14 Sucostl 4 Chmer view. () The sucostl 4C view cn e used to ssess chmer size nd function. Color flow nd spectrl Doppler imging cn e used to ssess vlvulr function. This is lso good view for ssessing for tril or ventriculr septl defects. () The sucostl view is good view for ssessing the presence nd size of pericrdil effusion Fig. 2.15 Inferior Ven Cv (IVC) view. Beginning in the sucostl 4C view nd rotting the trnsducer counterclockwise 90 nd ngling towrd the liver, the IVC cn e seen in long xis. The IVC cn e ssessed for dimeter nd collpsiility during respirtion. The size nd collpsiility of the IVC re used to estimte right tril pressure
20 Fig. 2.16 Suprsternl window. The suprsternl window is otined y plcing the trnsducer in the notch t the top of the sternum (the mnurium). This window is used for 2D imging nd lso for ssessment of ortic flows with dedicted continuous wve Doppler trnsducer (Pedoff proe) (Adpted from Servier Medicl Art, www.servier.com, with permission) Fig. 2.17 Suprsternl window. The suprsternl 2D imge is used to ssess the scending, trnsverse, nd descending ort nd its rnches. The inominte, left crotid, nd left suclvin rteries cn e seen rnching off the ort. The right pulmonry rtery cn lso e seen in short xis K.D. Horton
21 2 Bsic Ultrsound Views Fig. 2.18 Imge optimiztion overll gin. The gin controls the rightness of your imge. Optimizing the gin will result in etter detection of structures nd endocrdil orders. () Using excessive gin will result in imges tht re too right nd my mke norml structures ppering clcified. () Gins should e set t point tht lnce etween imge rightness nd drkness re reched Fig. 2.19 Imge optimiztion compression or dynmic rnge. Compression or dynmic rnge re controls tht ffect the numer of shdes of gry tht re displyed in the imge. () If these re set too high, the imge ppers wshed out nd it my e difficult to visulize endocrdil orders. () The compression or dynmic rnge should e set so the lood pool is drk nd the tissue is right. This will result in etter endocrdil order definition c Fig. 2.20 Imge optimiztion depth nd zoom controls. The imge depth nd zoom controls cn e used to optimize the re of interest. In these exmples () the depth is set too deep resulting in smll imge tht will e difficult to ssess, () the depth is set t the correct level so tht ll structures cn e seen in the picl 4C view, nd (c) the use of the zoom control for etter ssessment of the mitrl vlve
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