Ch 12 Suprasternal

Question 1

What are the 2 imaging planes we use in suprasternal?

Answer 1

-Long axis (SSN)
-Short axis (crab view)

Question 2

When would we use the short axis/crab view?

Answer 2

Is required in pediatrics

Question 3

When are SSN images usually taken during an echo?

Answer 3

At the end - typically the last imaging window acquired in a standard TTE exam

Question 4

How should the pt lie?

Answer 4

-In supine, turn head slightly to left/right
-Should lift their chin to extend their neck
-Remove pt’s pillow to extend neck even more

Question 5

Where is the probe placed with SSN?

Answer 5

In the supraclavicular fossa (base of neck)

Question 6

Where does the indicator face with SSN?

Answer 6

Towards pt’s left ear, approx 1 o’clock

Question 7

How do we tilt/angle our probe in the SSN view?

Answer 7

Very steep tilt inferiorly with an anterior angulation

(think the probe is “looking into” the SSN with an anterior enough position to see the Ao arch)

Question 8

List the structures seen in the SSN window?

Answer 8

-Ascending Ao (somewhat out of plane usually)
-Ao arch
-Descending thoracic Ao
-Brachiocephalic artery
-Left common carotid artery
-Left subclavian artery
-Right pulmonary artery (should always be seen)

(common to only have 2 of the arterial branches visible in one plane, sweep through to see others)

Question 9

What are other names for the Ao arch?

Answer 9

-TRV arch
-Aortic isthmus

Question 10

Another name for the brachiocephalic artery?

Answer 10

Innominate artery

Question 11

List the 3 vessels coming off the Ao arch?

Answer 11

-Brachiocephalic/innominate artery
-Left common carotid artery
-Left subclavian artery

Question 12

How can we optimize our image in the SSN?

Answer 12

-Rock to center image
-Heel/toe to pan b/w ascending or descending Ao
-Rotate in area b/w left ear + left shoulder to visualize all structures
-Steeper angulation allows for better visualization of descending Ao

Question 13

What vessel do we always want to see when imaging the SSN?

Answer 13

RPA (especially with pediatrics)

Question 14

What are we assessing for in the SSN?

Answer 14

-Ao size
-Any aneurysm or dissection
-Ao coarctation
-RPA dilation/thrombus/emboli
-Origin of vessels arising from Ao
-Sidedness of Ao

Question 15

CD allows delineation of what?

Answer 15

Direction + magnitude of flow

Question 16

What color will ascending + descending Ao flow be?

Answer 16

Asc: red
Desc: blue

(MUST interrogate these separately with individual + optimized CD boxes)

Question 17

What color will RPA flow be?

Answer 17

Blue

Question 18

How can we optimize our CD settings to look for areas of turbulence?

Answer 18

Adjust color scale + gain

Question 19

Due to higher velocities, aliasing is possible. However, large areas of mosaic colors/aliasing may indicate what?

Answer 19

Suspicion for localized stenosis

Question 20

In cases of moderate/severe Ao regurg, what will we visualize with CD?

Answer 20

Larger reversal in color

Question 21

What are we assessing when we put color on our SSN view?

Answer 21

-Direction + magnitude of flow
-Any localized areas of stenosis/dilation
-Any anomalous connections
-Presence of a PDA

Question 22

Why is the short axis/crab view not standardly acquired in adult echos?

Answer 22

-B/c not always possible to get in adults (therefore must evaluate long axis well)

-Only standard in pediatrics

Question 23

What is the crab view useful in examining?

Answer 23

The connections of the pulmonary veins to the LA

Question 24

Which PVs are seen in the crab view?

Answer 24

Depends on level of angulation, as different structures are visualized

(very steep angulation may be needed)

Question 25

Where is the indicator pointed in the crab view?

Answer 25

Roughly 3 o’clock

Question 26

List the structures seen in the crab view?

Answer 26

-RUPV (superior)
-LUPV (superior)
-RLPV (inferior)
-LLPV (inferior)
-LA
-Ao

Possibly:
-MPA
-RPA

Question 27

What structure is the body of the crab + what are the legs?

Answer 27

Body: LA
Legs: PVs

(these are the star of the show)

Question 28

Which PVs will present with red flow + which will present with blue flow into the LA?

Answer 28

Red: RLPV + LLPV
Blue: RUPV + LUPV

Question 29

Should we increase or decrease our CD scale to allow for PV filling?

Answer 29

Decrease it

Question 30

Areas of mosaic colors/aliasing may indicate what when imaging the crab view?

Answer 30

Suspicion for localized stenosis

Question 31

Lack of visualization of 4 PVs would lead to suspicion of what?

Answer 31

Anomalous pulmonary venous return