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Home Books The Atlas of Emergency Medicine, 5e

24-11: Parasternal Short-Axis View (PSSA)

Jeremy S. Boyd; Myles Melton; Jordan D. Rupp; Robinson M. Ferre

Technique

  • From the parasternal long-axis position, rotate the transducer 90 degrees clockwise (to the patient’s left) or place the transducer in the 4th or 5th left parasternal intercostal space in a line connecting the left clavicle/shoulder and the right hip (Fig. 24.38).

  • Identify the left ventricle (circular), right ventricle (crescent-shaped), and surrounding pericardium (Fig. 24.39).

FIGURE 24.38

Parasternal Short-Axis View. Place the transducer in the fourth or fifth left parasternal intercostal space in a line connecting the left clavicle/shoulder and the right hip, with the transducer rotated 90 degrees clockwise from the parasternal long-axis view. (Photo contributor: Lawrence B. Stack, MD.)

A patient lies in the supine position. A practitioner holds the transducer over the heart, to get a Parasternal Short-Axis View.
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A patient lies in the supine position. A practitioner holds the transducer over the heart, to get a Parasternal Short-Axis View.
FIGURE 24.39

Parasternal Short Axis. The left ventricle (circular) and right ventricle (crescent-shaped) and surrounding pericardium are seen. The papillary muscles are seen in cross-section. (Illustration contributor: Robinson M. Ferre, MD; ultrasound contributor: Shannon Snyder, MD, RDMS.)

An ultrasound image of a Parasternal Short-Axis view of the heart. The left ventricle appears in the center with two papillary muscles at its bottom, and the right ventricle to the left. The pericardium surrounds the heart. An illustration depicts a Parasternal Short-Axis view of the heart.
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An ultrasound image of a Parasternal Short-Axis view of the heart. The left ventricle appears in the center with two papillary muscles at its bottom, and the right ventricle to the left. The pericardium surrounds the heart. An illustration depicts a Parasternal Short-Axis view of the heart.
An ultrasound image of a Parasternal Short-Axis view of the heart. The left ventricle appears in the center with two papillary muscles at its bottom, and the right ventricle to the left. The pericardium surrounds the heart. An illustration depicts a Parasternal Short-Axis view of the heart.
View Full Size||Download Slide (.ppt)
An ultrasound image of a Parasternal Short-Axis view of the heart. The left ventricle appears in the center with two papillary muscles at its bottom, and the right ventricle to the left. The pericardium surrounds the heart. An illustration depicts a Parasternal Short-Axis view of the heart.

Abnormal Findings

  • Pericardial effusion: Anechoic (black) region noted between the bright pericardium and the walls of the heart (Fig. 24.37).

  • Dilated right ventricle: The right ventricle is normally a crescent-shaped structure. A rounded, dilated right ventricle that deforms the rounded left ventricle (creating an “OD” sign) suggests elevated right-sided pressures, as seen with pulmonary emboli and severe pulmonary hypertension (Fig. 24.40).

FIGURE 24.40

Parasternal Short Axis. A rounded, dilated right ventricle that deforms the rounded left ventricle (creating an “OD” sign) suggests elevated right-sided pressures. (Illustration contributor: Robinson M. Ferre, MD; ultrasound contributor: Jeremy S. Boyd, MD.)

An ultrasound image shows a Parasternal Short-Axis view of the heart and its internal structures. Diagonally in the center is a broad, flat septal wall between the ventricles. The septum wall is between the larger right ventricle on the left and D-shaped left ventricle on the right. An illustration depicts a Parasternal Short-Axis view of the heart.
View Full Size||Download Slide (.ppt)
An ultrasound image shows a Parasternal Short-Axis view of the heart and its internal structures. Diagonally in the center is a broad, flat septal wall between the ventricles. The septum wall is between the larger right ventricle on the left and D-shaped left ventricle on the right. An illustration depicts a Parasternal Short-Axis view of the heart.
An ultrasound image shows a Parasternal Short-Axis view of the heart and its internal structures. Diagonally in the center is a broad, flat septal wall between the ventricles. The septum wall is between the larger right ventricle on the left and D-shaped left ventricle on the right. An illustration depicts a Parasternal Short-Axis view of the heart.
View Full Size||Download Slide (.ppt)
An ultrasound image shows a Parasternal Short-Axis view of the heart and its internal structures. Diagonally in the center is a broad, flat septal wall between the ventricles. The septum wall is between the larger right ventricle on the left and D-shaped left ventricle on the right. An illustration depicts a Parasternal Short-Axis view of the heart.

Pearl

  1. The standard parasternal short-axis view is obtained with the image plane at the level of the papillary muscles. Visualization of the papillary muscles should ensure a true transverse section through the left ventricle, and provides a prime location for the evaluation of left ventricular contraction and motion.

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