Emergency Medicine Book


Left Intercostal Oblique Ultrasound View

Aka: Left Intercostal Oblique Ultrasound View, Left Coronal Ultrasound View
  1. See Also
    1. FAST Exam
    2. Subcostal Echocardiogram View (Subxiphoid Echocardiogram View)
    3. Right Intercostal Oblique Ultrasound View
    4. Right Coronal Ultrasound View
    5. Left Intercostal Oblique Ultrasound View
    6. Left Coronal Ultrasound View
    7. Suprapubic Ultrasound View (Long Axis or Longitudinal View)
    8. Lung Ultrasound for Pneumothorax (Sliding Lung Sign, Lung Point)
    9. Emergency Echocardiography
    10. Ultrasound
  2. Precautions
    1. Left Pleural Effusion is often missed on FAST Exam
      1. Do not forget to orient probe superiorly to visualize diaphragm
      2. Clinically important Pleural Effusions (or Hemothorax) will be clearly seen
  3. Approach: Left Intercostal Oblique Ultrasound View (LUQ)
    1. Transducer positioning
      1. Placement
        1. Hand resting on bed, holding transducer slightly above plane of bed
        2. Transducer posiition is at approximately 7th intercostal space
      2. Axis: Long axis with indicator at 12:00
        1. May rotate transducer to oblique with indicator towards 1-2:00 to reduce rib shadowing
      3. Direction: Energy perpendicular to lateral chest towards liver
      4. Precautions
        1. Push Knuckles into bed of hand holding transducer
        2. Most difficult view on the FAST Exam
          1. Adequate visualization of the Spleen and adjacent structures is challenging
          2. Transducer needs to be both higher in the chest and more posterior
    2. Landmarks
      1. Spleen
      2. Diaphragm
      3. Left Kidney may be visible in this view
    3. Conditions
      1. Left Hemothorax (same findings as on right)
    4. Additional measures (if time to evaluate incidental findings)
      1. Spleen can also be measured for Splenomegaly in this view (normal <12-14 cm)
    5. Images
      1. ultrasoundProbePositionLungFASTluq.jpg
      2. ultrasoundBMP_abdFastLUQ4.jpg
  4. Approach: Left Coronal Ultrasound View
    1. Obtain view by tilting transducer inferiorly from right intercostal view (or dropping down 1-2 rib spaces)
    2. Transducer positioning
      1. Placement: 1-2 interspaces below the Left Intercostal Oblique
      2. Axis: Long axis with indicator at 12:00
      3. Direction: Energy perpendicular to lateral Abdomen
        1. Pan transducer inferiorly to scan the inferior pole of Kidney
        2. Tilt transducer, sweeping from anterior to posterior Kidney
    3. Landmarks
      1. Spleen
      2. Left Kidney
      3. Left Psoas Muscle
    4. Conditions
      1. Blood superficial to Spleen or around splenic margins (most important to visualize)
      2. Blood may also collect between Spleen and left Kidney (but this is not typical)
      3. Blood in left Paracolic Gutter (between left Kidney and psoas Muscle)
    5. Images
      1. ultrasoundProbePositionLungFASTltPeriColic.jpg
      2. ultrasoundBMP_abdFastLUQpericolic.jpg
  5. Resources
    1. FAST Exam LUQ (Dr. Mandavia, Sonosite)
      1. http://www.youtube.com/watch?v=VBHCmw8iHCc
  6. References
    1. Reardon (2016) FAST Scan, Online Video Stabroom.com, accessed 4/1/2016
    2. Reardon (2013) Emergency Ultrasound Course, 3rd Rock Ultrasound, Minneapolis, MN
    3. Alameda County Trauma Service FAST Exam
      1. http://eastbay.surgery.ucsf.edu/eastbaytrauma/Protocols/ER%20protocol%20pages/FAST-files/FAST.htm
    4. Mateer (2012) Introduction to Trauma Ultrasound Video, GulfCoast Ultrasound, VL-95-T
      1. https://www.gcus.com/products/about.asp?product=338/Introduction-to-Trauma-Ultrasound
    5. HCMC FAST Exam
      1. http://vimeo.com/1044031

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