Double abdominal aorta artifact on ultrasound

Case contributed by Bálint Botz
Diagnosis not applicable


Right lower quadrant pain.

Patient Data

Age: 25 years
Gender: Female

"Double barrel" appearance of the abdominal aorta both on B-mode and color Doppler ultrasonography. The phenomenon is dependent on the angle of insonation and appears only when the beam passes through the linea alba, and disappears if the angle of insonation is changed. 

Otherwise unremarkable exam (not all images shown). 

CT was performed due to unrelated indications a few days later also confirming that the aortic anatomy is normal. 

Annotated image

The annotated image demonstrates that the double aorta is a consequence of the acoustic prism effect of the rectus abdominis muscles (blue), and the triangular area of fat below the linea alba (green). If the ultrasound beam passes through this area in the near-field, differing beam refraction can result in ghost images (indicated with dashed lines and light red color). 

Case Discussion

The double aorta artifact is not uncommon, and is usually encountered in thinner patients with otherwise ideal anatomy. The artifact can be typically completely removed by changing the angle of insonation, or by switching probe orientation to the sagittal plane, which reduces the aforementioned acoustic prism effect of the rectus muscles and adjacent fat. 

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