ECHO course

Standard Imaging Planes

Imaging of the heart by means of ultrasound is limited by thoracic anatomy. Air doesn't propagate ultrasound and because of this imaging of the heart is limited to several so-called 'acoustic windows'. These windows are left parasternal, apical, subcostal, suprasternal and right parasternal. Because of the properties of ultrasound intrathoracic fluid (for instance pleural or pericardial effusion) makes imaging easier but more intrathoracic air (COPD) makes imaging more difficult.

Parasternal Imaging Planes

The left parasternal imaging planes are found by placing the transducer in the third or fourth intercostal space on the left of the sternum. There are four standard imaging planes:

• parasternal long axis (PSLAX) and
• three parasternal short axis planes (SAX).

Left parasternal long axis

Image showing the left parasternal long axis transection (PSLAX) of the heart by the ultrasound waves

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A parasternal long axis

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Left parasternal short axis

Image showing the left parasternal short axis transection (SAX) of the heart and the different structures

Apical Imaging Planes

There are three apical imaging planes. these are made by placing the transducer on the ictus cordis and thus getting a four chamber view. By rotating the transducer counter clockwise, the two and three chaber views respectively are seen.

• Apical four chamber view

• Apical three chamber view

• Apical two chamber view