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Doppler Abdominal Aorta Assessment, Protocols, and Interpretation
Introduction
Doppler ultrasound is a valuable, noninvasive modality for evaluating the abdominal aorta, providing insights into systemic flow and perfusion. This procedure is convenient and cost-effective, eliminating the need for contrast administration, radiation exposure, and the limited availability associated with computed tomography and magnetic resonance imaging.[1][2][3] Integrating Doppler ultrasound into abdominal aorta assessment protocols can help identify conditions such as stenosis and aneurysms, as well as monitor vascular grafts following endovascular aneurysm repair.[4][5][6]
Anatomy and Physiology
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Anatomy and Physiology
Doppler Ultrasound Anatomy
On grayscale ultrasound, the abdominal aorta appears as a thin-walled, tubular structure on sagittal view and as a rounded structure on axial view. The abdominal aorta is located in the retroperitoneum, in the prevertebral space to the left of the inferior vena cava, the second largest vessel in this anatomic space. Initially, it lies in the midline in the upper abdomen, opposite to the T12 vertebral body. The aorta gradually shifts leftward as it descends to the level of the L4 vertebral body, opposite the umbilicus, where it bifurcates into its distal main branches, the right and left common iliac arteries. As it descends, it gives off multiple single and paired branches, and its diameter gradually narrows; females have narrower aortic diameters than males. The abdominal aorta gives origin to 4 unpaired branches—the celiac artery at the T12 level, the superior mesenteric artery at the L1 level, the inferior mesenteric artery at the L3 level, and the median sacral artery. In addition, 5 paired arterial branches are present—the inferior phrenic, middle suprarenal, and renal arteries at the L1-2 levels, gonadal arteries between the L2 and L3 levels, and lumbar arteries. The aorta terminates by bifurcating into the right and left common iliac arteries at the L4 level.
Color Doppler ultrasound examination reveals internal blood flow, whereas spectral sampling demonstrates a high-resistance multiphasic flow pattern.
Doppler Concept
Doppler imaging visualizes and measures blood flow by analyzing the interaction of ultrasound pulses with moving blood elements. As an extension of B-mode ultrasound, it is based on the same pulse-echo principle. Rapidly moving targets, such as red blood cells, produce distinct echoes that can be displayed as a color flow map (color Doppler) or a wave pattern (spectral Doppler).[3][7]
Ultrasound Doppler enhances and supplements other vascular imaging methods by providing functional data. Color Doppler ultrasound provides information about the presence or absence of flow, mean velocity, and flow direction within a selected region of interest, ie, the color box. Spectral Doppler imaging extends these functional data by tracing moving blood velocities over time, enabling quantitative assessment of absolute blood flow velocities and analysis of flow patterns.[2][3][7][8][9]
Indications
Doppler assessment of the abdominal aorta is critical for diagnosing and monitoring aortic pathologies, providing essential information for treatment decisions and follow-up. This modality is commonly used for the following:
- Diagnosis, screening, and follow-up of aortic aneurysms and pulsatile abdominal masses.[4][5][6]
- Evaluation of hypertensive patients: Initial diagnostic modality in the young population and handy follow-up modality for high-risk chronic patients to diagnose aortic wall hematomas, thrombi, and dissection.[10]
- Assistance in the diagnosis of some peri-aortic diseases, such as mid-aortic syndrome and retroperitoneal fibrosis.[11][12]
- Assessment of abdominal aortic involvement during screening and follow-up of large-vessel vasculitides, such as Takayasu arteritis.[13][14]
- Post-procedural surveillance of patients following endovascular aneurysm repair.[15]
Contraindications
Although there are no absolute contraindications, the effectiveness of Doppler ultrasound may be reduced in individuals with obesity, significant bowel gas, ascites, large ventral hernias, subcutaneous emphysema, or extensive aortic wall calcification.[13][16]
Equipment
Transducer Selection and Orientation
Low-frequency transducers with high penetration are essential for obtaining clear diagnostic images. Adult patients typically require operating frequencies ranging from 2.5 to 5.0 MHz, whereas pediatric patients may require frequencies up to 10 MHz. Adjusting the transducer frequency during the examination is essential to achieve optimal image quality based on the patient's body habitus. An effective Doppler ultrasound examination of the abdominal aorta requires selecting a transducer appropriate to the patient's body type and optimizing the balance between ultrasound penetration and image resolution. Low-frequency transducers, typically 2.5 to 5.0 MHz, provide sufficient penetration for adult patients, whereas high-frequency transducers, up to 10 MHz, offer higher resolution suitable for pediatric patients. Additionally, frequency adjustments should be made during the procedure to ensure the highest image quality.[17][18][19][17]
Personnel
Trained and qualified ultrasound technicians perform most peripheral ultrasound examinations in radiology and vascular labs. However, well-trained healthcare personnel can also provide point-of-care ultrasound triaging at the forefront of healthcare services.
Radiologists with adequate knowledge and qualifications interpret Doppler studies.
Practice Guidelines and Technical Considerations
Key practice parameters are essential for performing high-yield diagnostic and screening ultrasound examinations of the abdominal aorta:[20]
- Examination should be conducted by qualified personnel following standardized protocols to ensure precise results.
- The examination should assess the entire length of the abdominal aorta from various angles, extending from its diaphragmatic aperture (through a midline subcostal window) to the distal aortic bifurcation (about an inch below the umbilicus) with a global evaluation of the common iliac arteries.
- The interpretation of the findings should consider the patient's medical history and relevant risk factors.
Adherence to these guidelines is associated with a comprehensive and effective Doppler evaluation of the abdominal aorta.[8]
Preparation
No special preparation is required for Doppler ultrasound of the abdominal aorta in individuals with average body habitus and weight. However, for individuals with larger body habitus and obesity, minimizing bowel gas is important. Bowel gas reduction can be achieved by fasting overnight and avoiding activities that lead to air swallowing, such as smoking or chewing gum.[4][16]
Technique or Treatment
Understanding the protocols for performing Doppler assessment of the abdominal aorta and interpreting the results is crucial for accurate diagnosis and patient care.
Image Optimization
The greyscale ultrasound image depth should be adjusted to visualize the vertebral body behind the aorta, with the spine and aorta on the patient's left and the inferior vena cava on the patient's right. Bowel gas may impede image acquisition; techniques such as steady pressure or lateral decubitus can help displace it.[21]
To ensure unbiased Doppler analysis, the examiner must fine-tune the Doppler gain to achieve optimal diagnostic color and spectral signal saturation. This adjustment helps to avoid artifactual aliasing, a spectral ambiguity caused by disparities in the radiofrequency pulse of the Doppler source and the received flow velocities. On color Doppler, it manifests as patches of noisy, interwoven color hues. In spectral Doppler, it shifts the flow wave apex to the opposite side of the baseline.[7][21][22]
Examination Technique
The examination begins with greyscale scanning of the aorta in the axial plane, followed by complementary evaluation in the sagittal plane. Accurate measurement of the aorta and iliac artery segments—from the anterior leading edge to the posterior leading edge—should be obtained in both transverse and longitudinal planes. When an endograft is present, its attachment sites should be carefully documented.
Measurements of aortic diameter obtained by ultrasound can vary among practitioners, leading to inconsistent results. The cardiac cycle phase further impacts the assessment of aortic measurements. The vessel's complex geometry and surrounding tissue conditions are other confounding factors.[23] Recent research suggests that the most reliable method is to measure the aortic diameter using calipers from the outer wall to the outer wall or from the inner wall to the inner wall in both axial and sagittal planes.[24] For abdominal aortic aneurysm (AAA) surveillance, assigning a single trained observer to perform follow-up ultrasound Doppler imaging is recommended to ensure measurement consistency and reproducibility, highlighting the importance of examiner expertise.[25]
Following the greyscale scan, color and spectral Doppler should be used to assess the aorta, aneurysmal sac (if any), and any endografts in place. Color Doppler is deployed to address the luminal patency of the abdominal aorta qualitatively. Similarly, it assesses graft patency and detects abnormal blood flow patterns. Spectral Doppler should be employed to obtain samples from different aortic segments by placing a sample gate/window on the desired vascular segment to be assessed, ensuring the angle of insonation (the Doppler angle) is less than 60° for precise velocity measurements. Appropriate Doppler angle alignment can be achieved using a heel-to-toe maneuver, in which the transducer is gently tilted or angled along its long axis.[1][3][8][7][9]
Examination Extent
The Doppler examination of the abdominal aorta should begin with a gray-scale assessment that covers the entire length of the abdominal aorta and extends to the common iliac arteries. The scanning process typically commences in the midline from the substernal window to just below the umbilicus to include the iliac arteries as thoroughly as possible. The celiac and superior mesenteric arteries are important reference points for the proximal abdominal aorta, and the bifurcation of the common iliac arteries concludes the terminal abdominal aorta. Excessive transducer pressure should be avoided during abdominal aortic scanning to prevent potentially serious complications, including aneurysm rupture and patient injury.[1][2][3][7][9]
In an ideal world, both cine clips and still images of the greyscale and Doppler samplings of the abdominal aorta at different levels should be obtained. Nonetheless, diagnostic static image captures can be satisfactory if cine clips cannot be stored.
Complications
The ultrasound Doppler examination procedure is generally safe, with minimal known complications. Of note, as mentioned earlier, the examiner should avoid exerting excessive pressure during the abdominal aortic scan to prevent potentially serious complications such as aneurysm rupture.
Clinical Significance
Normal Abdominal Aorta Doppler Signature
The abdominal aorta's diameter decreases from the diaphragm's level to its bifurcation, with females having smaller aortic diameters.[26] The typical Doppler flow pattern in the aorta is antegrade and plug flow (characterized by constant velocity across the vessel) throughout the cardiac cycle, reflecting the bio-elastic buffering effect of the thoracic aorta during ventricular contraction and the characteristics of the vascular bed it supplies.[27][28][29]
The spectral trace above the inferior mesenteric artery branching off point displays a rapid systolic upstroke, followed by a swift return to baseline, brisk yet short early diastolic reverse, and low-velocity forward flow for the remainder of diastole, resulting in a triphasic pattern. This flow trace mirrors the low-resistive vascular beds of the splanchnic circulation, which require continuous perfusion.[30][31][32] In contrast, below the inferior mesenteric artery origin, the Doppler spectrum shows a relative decrease in the systolic flow peak, an increase in the volume of the early diastolic flow reversal, and a decrease or absence of late diastolic flow, resulting in a high-resistive biphasic pattern. This high-resistance flow trace reflects the capillaries' high resistance in the lower limbs' muscular beds (see Image. Normal Abdominal Aorta Doppler).[2][32]
In adolescents, normal peak systolic velocities in the abdominal aorta range from 110 to 120 cm/s.[2][30] With increasing age, these velocities decrease and typically range from 70 to 100 cm/s (see Image. Color and Spectral Ultrasound Doppler Images of Normal Abdominal Aortic Flow Pattern).[8][33][34]
Abnormal Abdominal Aortic Doppler
The abdominal aorta plays a crucial role in the functioning of abdominal organs and the lower body. Abnormalities in the abdominal aorta and its branches can lead to various acute or chronic conditions and align with patterns in the broader vascular system. Atherosclerosis, aneurysm, dissection, and arteritis are common issues.
Abdominal Aortic Aneurysm
An aneurysm is a focal enlargement of an artery, with an expansion of at least 50% beyond the vessel's usual diameter. An AAA is diagnosed when a dilated aorta with a diameter of 30 mm or greater is detected on imaging.[4][5][6][35][36] Diameters between 25 and 29 mm are considered sub-aneurysmal aortic diameters.[36] Academic discourse is increasingly focused on enhancing AAA screening effectiveness, specifically addressing sex-specific differences in rupture risk at smaller diameters, the necessity for inclusive protocols for women, particularly those with a smoking history, and the implications of population-based screening programs in non-Western countries, including Asia.[37][36][38][39][40]
Ultrasound is the preferred modality for screening and monitoring AAAs, as it eliminates the need for repeated exposure to radiation and contrast media used in computed tomography angiography (CTA).[4][5][6][35][36] Additionally, the ultrasound can effectively detect complications such as dissection, chronic rupture, and stent occlusions and exclude coexistent iliac artery aneurysms.
Individuals at higher risk for AAA should undergo diameter-adjusted interval screening to reduce morbidity and mortality.[36] High-risk groups primarily include males aged 65 or older; individuals with a family history of AAA; those with a history of smoking, hypertension, hypercholesterolemia, coronary artery disease, or peripheral arterial disease; and individuals with a first-degree relative with an AAA diagnosis.[41][42][43][44][45]
As stated earlier, Doppler ultrasound is used to diagnose an AAA when a segment of the infrarenal abdominal aneurysm has a diameter of 30 mm or greater. The dilation may be fusiform (in line with the main aorta) or saccular (eccentric segment dilation). A mural echogenic thrombus or intimal calcifications are typically detected (see Image. Greyscale Ultrasound of an Abdominal Aortic Aneurysm).
Color Doppler imaging typically shows swirling arterial flow (Yin-Yang/ Korean flag sign) within the aortic aneurysmal sac (See Image. Color and Spectral Ultrasound Doppler Images of an Abdominal Aortic Aneurysm)
AAAs are associated with serious complications such as dissections and ruptures. In acute or chronic vascular dissections, greyscale images reveal an intraluminal linear echogenic intimal flap that syncs with arterial pulsations. Additionally, color Doppler imaging delineates 2 distinct flow channels on each flap side during diastole, indicating the true and false lumens.[46][47] Suspicion of a silent ruptured aneurysm arises when there is an intimal defect or ulceration between the lumen wall and an adjacent thrombus, asymmetrical or unilateral hypoechogenicity near the aorta, and varying amounts of free fluid in the peritoneal cavities. In addition, color Doppler interrogation shows no color flow.[48][49][50]
Ultrasound Doppler is commonly used to monitor post-endovascular aortic repair complications, such as graft limb stenosis and endoleaks. Careful attention to Doppler settings is needed to detect extra-stent flow and differentiate true endoleak flow from artifactual apparent flow.[15][51]
Three-dimensional ultrasound technology has emerged as an alternative to CTA for measuring AAA diameter and for monitoring post-endovascular aortic repair. Three-dimensional ultrasound involves the concurrent acquisition of multiplanar two-dimensional ultrasound image data, enabling analysis in transverse, coronal, and sagittal planes similar to computed tomography images while obviating the need for contrast administration and reducing radiation exposure.[52][53]
Doppler of Endoleaks
Endovascular aneurysm repair is a safe and widely adopted management approach that is increasingly favored for treating high-risk patients with AAA, particularly older individuals with multiple comorbidities.[36][54]
Endoleak, a peri-graft flow into the aneurysm sac, is the most common complication after endovascular aneurysm repair. Endoleaks are commonly classified into 5 common types (see Table. Types of Endoleaks and Their Standard Criteria).[55]
Table 1. Types of Endoleaks and Their Standard Criteria
|
Endoleak |
Definition/Descriptor |
|
Type I |
Attachment site leak-proximal or distal The most common early post-intervention complication |
|
Type II |
Collateral vessel-leak The most common overall type Aneurysm sac fills with blood from the aortic branches |
|
Type III |
Graft failure Stent junctions may fracture due to arterial pulsation and aneurysm pressure |
|
Type IV |
Graft wall porosity caused by inherent stent material deficiencies |
|
Type V |
Endotension Aneurysm sac growing on its own. Reason unknown. |
Endovascular aneurysmal repair requires a strict imaging surveillance protocol to identify potential complications, including endoleak, potential stent re-occlusion, or the development of a para-anastomotic aneurysm.[51][55][36] Doppler ultrasound is the preferred modality, as it reduces radiation exposure, avoids contrast-related risks, and is more cost-effective compared to CTA.[56][57][58][54] Furthermore, Doppler ultrasound offers a significant advantage compared to CTA by identifying the flow direction in endoleaks.[59] Reports indicate that duplex ultrasound scans showing endoleak nidus velocities exceeding 100 cm/s are unlikely to close independently.[60][61]
On color Doppler ultrasound, type I endoleaks are identified by color flow at the graft's landing zones. On the other hand, type II endoleaks show retrograde flow in the inferior mesenteric and lumbar arteries, with to-and-fro flow in the excluded sac. In type III endoleaks, a color flow is detected in the sac around the graft in a central position.[62] In types IV and V, serial imaging shows increasing sac diameter.
Type I and III endoleaks require prompt intervention, whereas type II endoleaks may resolve spontaneously and often require only regular follow-up.[15][55][36]
Aortic Coarctation
In some cases, a chest x-ray may identify localized aortic indentation and rib notching, suggesting a diagnosis of coarctation of the aorta.[63] However, Doppler spectral flow in the abdominal aorta provides greater insight into the condition of the descending thoracic aorta. The presence of significantly reduced systolic spectral velocities, a lack of early diastolic reverse flow, and a strong diastolic phase that allows for continuous forward flow—known as the tardus parvus pattern (tardus means "delayed acceleration" and parvus refers "low velocity")—may indicate a severe proximal stenotic lesion, such as aortic coarctation, necessitating further cross-sectional vascular imaging.
A clear interpretation of a precise spectral wave pattern requires consideration of the patient's clinical history and previous diagnostic tests to avoid misinterpretation due to confounding factors such as obstruction length, the presence of a patent ductus arteriosus, collateral circulation status, and decreased cardiac output in severe coarctation. Importantly, end-diastolic reversal effectively rules out significant aortic coarctation.[64]
Uncommon forms of aortic coarctation affecting the abdominal aorta include congenital developmental anomalies of the aorta;[65][66][65] inflammatory conditions, such as Takayasu arteritis;[65] and non-inflammatory conditions, such as fibromuscular dysplasia.[66] Contemporary literature generally considers these conditions under the umbrella of the mid-aortic syndrome.
Middle Aortic Syndrome
Middle aortic syndrome is a sub-isthmic coarctation of the distal thoracic or proximal abdominal aorta and its major splanchnic branches. Collateral pathways, such as the internal mammary artery or the arc of Riolan, may become enlarged to bypass the stenotic segment.[67][66] Sonographic findings of middle aortic syndrome include segmental narrowing of the abdominal aorta, turbulent flow (color Doppler aliasing), and focal peak systolic velocities (>200 cm/s) in the stenotic segment. Furthermore, the depiction of the tardus parvus spectral Doppler trace in vessels distal to the stenotic area (eg, the superior mesenteric and renal arteries) is an indirect sign of significant upstream stenosis. The tardus parvus describes a spectral trace showing reduced peak systolic and elevated end-diastolic flow velocities, with an overall prolonged flow time due to the loss of pulsatile energy from the proximal stenosis.[11][68][69][70][71]
Doppler ultrasound is a valuable tool for identifying potential causes of mild smooth stenosis of the abdominal aorta. This tool can identify slab- or strip-like isoechoic lesions around the aorta with minimal blood flow signal in retroperitoneal fibrosis or visualize the thickening of the vascular wall and perivascular halo in vasculitis. Furthermore, it can evaluate collateral circulation in response to stenosis.[12][72]. Further angiographic imaging using CTA or MRA may be warranted.[11][73]
Large-Vessel Vasculitis/Takayasu Aortitis
Large vessel vasculitides are divided into 2 main types—Takayasu arteritis and giant cell arteritis. Takayasu arteritis primarily affects young females and involves large central arteries such as the aorta and pulmonary arteries. In contrast, giant cell arteritis is less common in individuals younger than 50, shows a higher prevalence in males, and most frequently involves the superficial temporal artery and other large peripheral arteries.[74][75]
Takayasu arteritis, also known as pulseless disease, is a chronic inflammatory pan-aortitis involving an intricate interplay of immune processes, genetic factors, and vascular remodeling. This disease often initially presents in children and adolescents with systemic symptoms such as malaise, fever, night sweats, weight loss, and joint pain, accompanied by anemia and elevated inflammatory markers. In the early phases, imaging shows a thickening of the arterial wall. As the condition progresses into a late-quiescent phase, the inflammatory changes subside, leading to stenosis, thrombosis, and aneurysm formation. In this phase, patients often experience complications leading to symptoms such as limb ischemia or renovascular hypertension.[75][76]
Ultrasound is crucial for screening and diagnosing large-vessel vasculitis. Fast-tracking adults and pediatric patients with suspected large-vessel vasculitis or fever of unknown origin is recommended to detect Takayasu arteritis at an early stage.[14][77] The primary focus is the identification of intima-medial and adventitial wall thickening due to inflammation, which leads to segmental or diffuse abdominal aortic lumen narrowing on greyscale imaging, giving the halo sign of vasculitis. Color Doppler may show increased peri-aortic adventitial vascularity in active phases and disappear in remission.[78][79] Doppler interrogation typically reveals abnormally elevated systolic velocity and a shift from the triphasic to monophasic forward flow pattern in patients with Takayasu arteritis.[3][8][13][80] Doppler ultrasound is a valuable tool for detecting complications, such as vascular dissections.[81][82]
Atherosclerosis and Occlusive Arterial Disease
Atherosclerosis is a systemic, multifactorial disorder that affects medium- and large-sized arteries. This disease is characterized by thickening of the vessel wall, especially the intima, with the formation of degenerative plaques and subendothelial deposits of low-density lipoprotein cholesterol. Ultrasound has been used to visualize and quantify atherosclerotic plaques as potential prognostic markers of future cardiovascular events.[83]
Atherosclerosis is characterized by focal irregularities and calcifications on the inner surface of the AA, whereas the adjacent inferior vena cava has a smooth inner surface.[84][85] These vascular changes often lead to peripheral arterial aneurysms, especially popliteal artery aneurysms, which are strongly associated with AAAs.[86][87] Doppler ultrasound detects the total plaque area or volume. Furthermore, it assesses aortic arterial stiffness, providing crucial data for planning surgical or interventional treatments by estimating blood flow and velocity, correlating with stenosis severity.[84][85] Patients with proximal peripheral arterial disease and severe stenosis or occlusion of the distal abdominal aorta and iliac arteries often display a mid-systolic notch in the Doppler spectrum of the descending aorta. This finding is attributed to a reflected backward pressure wave at the stenotic site that dampens the systolic peak.[88]
Leriche syndrome is an unusual form of chronic occlusive atherosclerosis that primarily affects the aorta and iliac arteries. This syndrome is often linked to risk factors such as smoking, high cholesterol, and high blood pressure.[89][90] Most patients are asymptomatic because collateral blood vessels develop to supply the lower limbs, reducing the risk of acute ischemic events.[89][90][91] Ultrasound Doppler imaging typically shows limited color flow in a highly narrowed vessel, often with large, hypoechoic atherosclerotic plaques in the affected area.[91] When conducting examinations, it is crucial to carefully adjust parameters to avoid missing low-velocity flow by increasing the Doppler gain and adjusting the color scale.[7] A monophasic waveform and reduced peak systolic velocities in the common femoral arteries downstream of the blockage can confirm proximal iliac artery occlusion.[91] Currently, angioplasty and stenting are the primary treatments for Leriche syndrome, with open surgery being reserved as an alternative for extensive disease and in cases of failed endovascular intervention.[92][93]
Enhancing Healthcare Team Outcomes
Doppler ultrasound plays a critical role in assessing the abdominal aorta, identifying stenosis, aneurysms, and complications, and monitoring vascular grafts. However, its effectiveness as a screening tool is limited by operator dependency, and additional angiographic imaging with CTA or MRA is often warranted when abnormal findings are detected in a clinically suspicious setting.
To ensure high-quality outcomes, the treating teams must collaborate, emphasizing patient-centered care. Clinicians requesting Doppler evaluations should have the qualifications and skills to understand the impact of aortic diseases and provide comprehensive clinical information justifying the necessity of the assessment. Radiology services should provide qualified personnel capable of conducting satisfactory diagnostic examinations and interpreting findings accurately, considering the patient's medical history and relevant risk factors to ensure the reliability of the results. Another essential strategy is to incorporate point-of-care ultrasound into healthcare training programs for healthcare providers at all levels. This approach can expedite the identification and management of critical abdominal aortic emergencies, thereby improving patient outcomes. Point-of-care ultrasound is a dependable, cost-effective diagnostic tool used in emergency departments, underserved areas, and budget-constrained health systems to detect abdominal aortic abnormalities, especially aneurysms, and their complications. These efforts significantly advance patient-centered care and play a vital role in optimizing outcomes within the broader healthcare system.
Media
(Click Image to Enlarge)
Normal Abdominal Aorta Doppler. Longitudinal color and spectral Doppler images show normal abdominal aorta color saturation and spectral triphasic pattern.
Contributed by M Ahmed, MD
(Click Image to Enlarge)
Color and Spectral Ultrasound Doppler Images of Normal Abdominal Aortic Flow Pattern. Abdominal aortic aneurysm. Axial (A) and sagittal (B) scans. Note the eccentric, echogenic mural thrombus.
Contributed by H Ibrahim, MD
(Click Image to Enlarge)
Greyscale Ultrasound of an Abdominal Aortic Aneurysm. Longitudinal color and spectral Doppler images show turbulent bidirectional color saturation within the aneurysm (Korean flag sign) with echogenic mural thrombus and a low-resistance, bidirectional waveform.
Contributed by M Amer, MD
(Click Video to Play)
Color and Spectral Ultrasound Doppler Images of an Abdominal Aortic Aneurysm. This ultrasound video demonstrates the inferior vena cava—the collapsible vessel located posteriorly and to the patient’s right (appearing on the left side of the screen)—and the abdominal aorta, which remains round and lies anteriorly and to the patient’s left (appearing on the right side of the screen).
Contributed by R Gibbons, MD, FAAEM
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