Suprasternal view
How to acquire Suprasternal view?
- Position the patient supine with a pillow behind the shoulders so they can tilt their head backwards.
- Turn the patient’s face to his left shoulder and place the probe in the suprasternal notch (SSN) or alternatively at the right supraclavicular position.
- The marker should be pointing to 12 o’clock initially with gradual clockwise rotation toward the left shoulder (1 o’clock).
- The SSN view is important for evaluation of the aortic arch and the origins of the three major supra-aortic arteries – innominate, left carotid and left subclavian artery.
- This view should be used whenever aortic disease is evaluated.
- Variable lengths of the descending and ascending aorta may be seen. The right pulmonary artery may be seen in cross-section.
- This view may be impossible to acquire in patients with emphysema or short, wide necks, ask the patient to exhale during the examination for better access.
Image 1 Suprasternal view - marker pointing to 12 up to 1 o’clock
Structures visualized in Suprasternal long-axis view
- ascending aorta
- aortic arch
- proximal descending thoracic aorta
- origins of the three main arteries – right brachiocephalic, left common carotid and left subclavian artery
- corresponding veins superior to the aortic arch
- superior vena cava – adjacent to the ascending aorta
What pathology can be visualized from Suprasternal view
- Aortic coarctation – functional evaluation by Colour Doppler
- Dilatation and aneurysm of the aorta
- Retrograde flow in the descending aorta using the CFD in Aortic regurgitation quantification
- Degree of calcification and plaque formation
- Intimal flap of the aortic dissection
- Thrombus
Video 1 Aortic arch with its branches and proximal descending aorta - suprasternal long axis view
Image 2 Suprasternal view anatomy
Video 2 Aortic arch with its branches and proximal descending aorta - suprasternal long axis view, normal Color doppler in descending aorta
Image 3 Normal flow gradients in Aorta descendens
Video 3 Increased flow velocities apparent in a patient with coarctation of aorta
Image 4 Peak systolic gradient of 70 mmHg measure with CWD
Image 5 Flow in proximal descending aorta - Holodiastolic flow reversal in descending aorta=corresponding to severe AR (0.30 m/s)
Image 6 Measurement of an aortic arch - suprasternal long axis view
Video 4 Aorta descendens
Image 7 Pulse doppler flow in Aorta descendens
Image 8 Aorta descendens diameter= normal diameter (18 mm)
Suprasternal short-axis view
- From the suprasternal long-axis view, rotate the probe 90° clockwise.
- Aortic arch is visualized in a cross section.
- Pulmonary artery is imaged in the long axis by tilting the transducer anteriorly (the transducer is almost touching the patient’s neck)
- By tilting inferiorly, you can see the left atrium and the pulmonary veins entering it.
- This view may be used for LA anatomy evaluation and for venous inflow into the left heart.
References
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003. PMID: 25559473.
- Otto, C. M. (2018). Textbook of clinical echocardiography.
- Suprasternal Window | 123 Sonography. Online Echocardiography Course & Sonography Training | 123 Sonography [online]. Accessible at: https://www.123sonography.com/ebook/suprasternal-window
- Evangelista A, Flachskampf FA, Erbel R, Antonini-Canterin F, Vlachopoulos C, Rocchi G, Sicari R, Nihoyannopoulos P, Zamorano J; European Association of Echocardiography; Document Reviewers:, Pepi M, Breithardt OA, Plonska-Gosciniak E. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr. 2010 Sep;11(8):645-58. doi: 10.1093/ejechocard/jeq056. Erratum in: Eur J Echocardiogr. 2011 Aug;12(8):642. PMID: 20823280.
