At this point, you should feel confident in how to obtain the abdominal views.

If you do not feel confident, please review the previous topics.
If you do feel confident – now move on to answering the focused questions.

The focused questions in focused ultrasonography of the abdomen are:

In adults, the normal largest abdominal aortic diameter is <3.5 cm

Above 3.5 cm, there is an exponentially increasing risk of rupture within the next 5 years with increasing maximal diameter size, but the size at rupture is >5.0 cm in 90% of cases.

Ruptured abdominal aortic aneurism is a clinical diagnosis – no ultrasonographic findings can rule out a ruptured aneurism.

However, the classical triad of pain, hypotension and pulsatile abdominal mass due to rupture is only seen in 25-50% of patients and ultrasonography may aid the diagnosis.

To look for free fluid in the abdomen, three views are relevant:

In the perihepatic view, the following structures are seen:

In the perisplenic view, the following structures are seen:

The perisplenic view is obtained in the same way as perihepatic view.

Be aware that a slight rotation on the transducer in order to avoid rib shadowing should be done with a clockwise rotation as opposed to the counter-clockwise rotation in the perihepatic view.

In the transverse aortic view, the following structures are seen:

The learning objectives for focused ultrasonography of the abdomen are

To obtain
– the transverse and longitudinal aorta view
– the perihepatic view
– the perisplenic view
– the pelvic view

To answer the focused questions
– Is abdominal aortic aneurism/dissection present?
– Is free intraperitoneal fluid visible?