Here is a quick case for today. We were looking at ultrasound images for our weekly quality assurance and came across the following images on a study of an aorta:

transposition mid

 

transposition distal

 

 

What do you notice? First of all, the clip shows the bifurcation of the distal aorta into the iliac arteries if you study it closely.

 

Here are some labels that might help to further clarify:

transposition mid

 

transposition distal

 

These are images of the abdominal aorta in transverse view. What seems wrong? The aorta appears on the left side of the screen, which would be the patient’s right. The inferior vena cava is to the right side of the screen (patient’s left). This is not anatomically normal. Here is as schematic of what the normal anatomic positions should be on a transverse view:

 

Screen Shot 2015-07-06 at 11.16.32 AM

Here are a couple of clips of what a normal aorta looks like in transverse view:

 

 

It is July, and our first thought was that it was probably a new intern holding the ultrasound transducer backward (with the indicator toward the patient’s left), thus, creating an image that is flipped.

 

Were were wrong though! We pulled up the patient’s CT scan that was done during the same visit for abdominal pain:

Screen Shot 2015-07-06 at 11.29.29 AM

 

Screen Shot 2015-07-06 at 11.28.51 AM

You can see that the IVC is to the patient’s left compared to the aorta. Interestingly, all of the other organs are in the correct anatomic positions.

 

The patient’s abdominal pain was not felt to be related to this anatomic variant. This was a great pick-up by the sonographer that we were assuming was holding the transducer the wrong way!

 

 

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