POCUS Learning Modules

MODULE 5:  AAA Screening & IVC US

Curriculum Location: Surgery / Total Time: 1.5 hours

For this and all other modules, you are welcome and encouraged to take notes as helpful to you in your Ultrasound/POCUS for Family MedicineEvernote Notebook, found here. 

Learning Module Objectives:

  1. Perform a screening exam of the abdominal aorta for aneurysm (AAA).

  2. Utilize ultrasound to triage a patient with pulsatile abdominal mass concerning for an abdominal aneurysm.

  3. Locate the IVC and differentiate the IVC from the aorta.

  4. Evaluate the IVC for diameter and collapsibility to estimate a patient’s CVP/volume status.

Abdominal Aorta & AAA Screening US (Time: 30 minutes)

  1. Background Case: Pulsatile abdominal mass in a smoker

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding renal ultrasound.

    2. Case description: A 65 year old male smoker with a history of nonadherence to additional testing due to costs and travel presents to you in your rural office for a check-up for his hypertension. He is asymptomatic. On exam, his vitals are normal and you note a nontender pulsatile abdominal mass. He has not had AAA screening. You order an urgent US but are concerned he might not get it done in timely fashion.

    3. Case Question: How can POCUS be used to augment your exam and improve this patient’s outcome? Can a physician use POCUS to perform a full AAA screen in the office? Can he or she bill for it? How do you perform a AAA screen with POCUS?

  2. Assignments:

    1. POCUS can be utilized to assess a pulsatile mass and/or for primary screening for AAA. Watch the following SUSME introductory video: Abdominal Aorta Assessment for AAA

    2. Review just the AAA (top) section of this UP page: http://www.ultrasoundpaedia.com/normal-abdominal-vascular/

    3. Now, review this abnormal aortic US noting how to measure and assess a aortic aneurysm and thrombus: https://sonoworld.com/CaseDetails/Aortic_aneurysm_with_intraluminal_thrombus.aspx?ModuleCategoryId=279

IVC US (Time: 20 minutes)

  1. Background Case: Dyspnea and Edema

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding IVC ultrasound.

    2. Case Summary: A 55 year old female with a PMH of Obesity, HTN, COPD, and HFpEF/Gr2 Diastolic Dysfunction presents with worsening dyspnea. On exam, her vitals are normal, her lung sounds are distant with slight rhonchi and wheezing, and you are not sure if JVD is present. She has 2+ pitting edema. You are concerned about volume overload vs uncontrolled COPD or a COPD exacerbation. You decide to use POCUS to augment your exam by evaluating the patient’s IVC to assess her volume status..

    3. Case Questions: How is POCUS used to evaluate the IVC to estimate a patient’s volume status?

  2. Assignments:

    1. Evaluating volume status with measurement of the IVC is a popular use of POCUS in outpatient and inpatient settings. The IVC is generally easy to find and its diameter and collapsibility can be used to estimate Central Venous Pressure, similar to how we can measure Jugular Venous Pressure on physical exam.

    2. To learn the basics of IVC US, first watch the following SUSME introductory video: IVC Ultrasound

    3. Now, watch this 2 minute summary and note the comments on the Middle Hepatic Artery and avoiding the error of the “Cylinder Effect”: https://www.youtube.com/watch?v=j5aboEF2-qo

Module QUIZ (Suh-weet!) (Time: 10 minutes)

Congratulations on completing the module.  Please click HERE to take your Module Quiz and provide Module feedback.