We normally visualise the aorta on ultrasound by scanning down the midline. However, we frequently fail to visualise the entire aorta. The view is often obscured by bowel gas. Abdominal pain often makes the examination intolerable. A small proof-of-concept study in AJEM suggest a right lateral approach, using the liver as an acoustic window, improves visualisation.

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Studer et al. scanned 60 patients using both the traditional midline transverse approach as well as a lateral midaxillary longitudinal view. The goal was to visualise the entire aorta from the ciliac axis to the bifurcation. The visualisation was considered adequate if more than two thirds of the aorta could be seen.

Using the midline approach, visualisation was adequate in 48,2% of patients.
Using the right lateral approach, visualisation was adequate in 59,2% of patients.
By combining the two views, adequate visualisation could be achieved in 75,9%.

Paper lives here:
Addition of a lateral view improves adequate visualization of the abdominal aorta during clinician performed ultrasound.
Studer M, Hempel D, Rouhani S, Dubsky H, Pivetta E, Kimberly HH.
Am J Emerg Med. 2014 Mar;32(3):256-9. 

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