Saturday, 27 June 2026

Parasternal Left Ventricular Long-Axis View PLVLA (2D Echo )

2D Echo
📄 SonoAcademy

Parasternal Left Ventricular
Long-Axis View (PLVLA,2D)

Parasternal left ventricular long-axis view. (a) Diastole. (b) Systole

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Reporting Panel

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Cardiac Pathology

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Case Study

PLVLA,2D PLVLA,2D

Parasternal Left Ventricular Long-Axis View (PLVLA) is one of the most important standard two-dimensional (2D) transthoracic echocardiographic views. It provides a longitudinal image of the heart, allowing detailed evaluation of the left ventricle, left atrium, mitral valve, aortic valve, left ventricular outflow tract (LVOT), aortic root, interventricular septum, left ventricular posterior wall, and ascending aorta. The PLVLA view is routinely used to assess cardiac anatomy, chamber dimensions, ventricular systolic function, wall thickness, valvular morphology, and aortic root abnormalities. It also serves as the primary reference view for M-mode measurements and quantitative assessment during a comprehensive echocardiographic examination.

Image 1 Image 2 Image 3 Image 4 Image 5 Image 6
1. Introduction
The Parasternal Left Ventricular Long-Axis (PLVLA) view is one of the fundamental transthoracic echocardiographic imaging planes. It provides a long-axis section of the heart, allowing visualization of the left ventricle, left atrium, mitral valve, aortic valve, left ventricular outflow tract (LVOT), aortic root, interventricular septum, and left ventricular posterior wall. This view is essential for routine cardiac examination and quantitative assessment of chamber size, ventricular function, valvular morphology and aortic root pathology.

Commonly Used PLVLA View Abbreviations

Abbreviation Full View Name
PLVLA Parasternal Left Ventricular Long-Axis View
PSAX Parasternal Short-Axis View
A4C Apical Four-Chamber View
A2C Apical Two-Chamber View
A3C / APLAX Apical Three-Chamber View / Apical Long-Axis View
A5C Apical Five-Chamber View
SC4C Subcostal Four-Chamber View
IVC Inferior Vena Cava View
SSN Suprasternal Notch View
2. Scanning Method
Patient Position
  • Supine or left lateral decubitus position.
  • Left lateral position improves visualization.
Transducer
  • Phased-array cardiac probe.
  • Frequency: 2–5 MHz.
Probe Position
  • Left parasternal border.
  • 2nd–5th intercostal space.
Probe Marker

Directed toward the patient's right shoulder (10 o'clock).

Technique
  1. Place probe beside the sternum.
  2. Adjust depth and gain.
  3. Rotate and angle until LV, LA, MV, AV, LVOT and aortic root are visualized.
  4. Freeze the best image for measurement.
3. Section Structure
Structures Visualized
  • Right Ventricular Outflow Tract (RVOT)
  • Interventricular Septum (IVS)
  • Left Ventricular Cavity (LV)
  • Left Ventricular Posterior Wall (LVPW)
  • Mitral Valve
  • Left Atrium
  • Aortic Valve
  • Left Ventricular Outflow Tract
  • Aortic Root
  • Ascending Aorta
  • Pericardium
4. Measuring Method and Normal Values

Posterior–anterior dimensions of the left ventricular cavity, right ventricular cavity, and left atrial cavity can be obtained in this view. The left and right ventricular cavities are measured at the level of the mitral valve chordae during diastole. The normal left ventricular internal diameter is 38 ± 10 mm, while the normal right ventricular internal diameter is 25 ± 10 mm. The left atrial diameter is 33 ± 5 mm, measured at the middle of the left atrium during systole. The aortic valve annulus measures 20 ± 4 mm from the anterior inner edge to the posterior inner edge at the attachment of the aortic valve during systole. The aortic sinus measures 26 ± 8 mm from the anterior inner edge to the posterior inner edge at the level of the sinus of Valsalva during systole. The ascending aorta measures 25 ± 10 mm at a point 2 cm above the aortic sinus during systole. The coronary sinus measures 7 ± 4 mm in the anterior–posterior dimension from the anterior inner edge to the posterior inner edge.

Measurement Normal Value
IVSd 6–10 mm
LVIDd Male 42–59 mm
Female 39–53 mm
LVIDs 25–40 mm
LVPWd 6–10 mm
Left Atrial Diameter 27–40 mm
Aortic Root Diameter 20–37 mm
Ejection Fraction 55–70%
Fractional Shortening 28–44%
5. Clinical Application
  • Assessment of LV size.
  • Evaluation of LV systolic function.
  • Wall thickness measurement.
  • Mitral valve assessment.
  • Aortic valve assessment.
  • Aortic root measurement.
  • LVOT evaluation.
  • Detection of pericardial effusion.
  • Follow-up of cardiomyopathy.
  • Assessment of hypertensive heart disease.
6. Diagnosable Pathology
  • Left Ventricular Hypertrophy (LVH)
  • Dilated Cardiomyopathy (DCM)
  • Hypertrophic Cardiomyopathy (HCM)
  • Left Ventricular Systolic Dysfunction
  • Regional Wall Motion Abnormality (RWMA)
  • Mitral Valve Prolapse (MVP)
  • Mitral Stenosis (MS)
  • Mitral Regurgitation (MR)
  • Aortic Stenosis (AS)
  • Aortic Regurgitation (AR)
  • Aortic Root Dilatation
  • Pericardial Effusion
  • Infective Endocarditis
  • LVOT Obstruction
  • Intracardiac Mass or Thrombus

SonoAcademy Digital MCQ Examination

Topic: Parasternal Left Ventricular Long-Axis View (PLVLA) – 2D Echocardiography

Total Questions: 10 | Total Marks: 10 | Time: 30 Minutes

Instruction: Enter your details, start the examination, answer all questions, submit the examination, and download your PDF marksheet after completion.

Exam Result

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Topic: Parasternal Left Ventricular Long-Axis View (PLVLA) – 2D Echocardiography

Total Marks: 10

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Friday, 26 June 2026

2D Echocardiography Study Guide

2D Echo
📄 SonoAcademy

2D Echo
Study Guide

2D Echocardiography Study Guide

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Reporting Panel

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Cardiac Pathology

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Case Study

2D Echo H

Basic Views of B-Mode Echocardiography are standard two-dimensional ultrasound views used to evaluate cardiac chambers, valves, septa, pericardium, ventricular function, and major vessels. Proper image acquisition helps in accurate diagnosis, documentation, and follow-up of cardiac abnormalities.

Image 1 Image 2 Image 3
🔶 Introduction

B-mode echocardiography, also called two-dimensional echocardiography, is a real-time ultrasound technique used to visualize cardiac anatomy and motion. It provides grayscale images of the heart and helps assess chamber size, wall motion, valve morphology, septal integrity, pericardium, and great vessels.
🔶 Clinical Indications

1. Chest pain or suspected cardiac disease.
2. Dyspnea or heart failure assessment.
3. Murmur evaluation.
4. Valvular heart disease.
5. Cardiomyopathy.
6. Congenital heart disease screening.
7. Pericardial effusion assessment.
8. Follow-up after cardiac treatment or surgery.
🔶 Patient Preparation

No special fasting is usually required. Explain the procedure to the patient. The patient is commonly positioned in the left lateral decubitus position to improve acoustic access. ECG leads may be attached if required. Apply adequate ultrasound gel to obtain good probe contact.
🔶 Equipment

Ultrasound Machine: Echocardiography-capable system.
Probe: Phased-array cardiac transducer, commonly 2–5 MHz in adults.
Modes: B-mode, M-mode, Color Doppler, Pulsed-Wave Doppler, Continuous-Wave Doppler, and Tissue Doppler if available.
Accessories: ECG cable, ultrasound gel, patient couch, and image recording system.
🔶 Structures Evaluated

1. Left atrium and right atrium.
2. Left ventricle and right ventricle.
3. Mitral, tricuspid, aortic, and pulmonary valves.
4. Interventricular and interatrial septa.
5. Left ventricular outflow tract and right ventricular outflow tract.
6. Aortic root and ascending aorta.
7. Pulmonary artery.
8. Pericardium and pericardial space.
🔶 Routine Measurements

1. Left ventricular internal diameter in diastole and systole.
2. Interventricular septal thickness.
3. Posterior wall thickness.
4. Left atrial size or volume.
5. Aortic root diameter.
6. Ejection fraction estimation.
7. Right ventricular size and function.
8. Pericardial effusion measurement if present.
🔶 Normal Findings

Normal B-mode echocardiography shows normal chamber size, preserved ventricular contraction, normal valve opening and closing motion, intact septa, no obvious intracardiac mass or thrombus, no significant pericardial effusion, and normal relationship of great vessels.
🔶 Common Abnormal Findings

1. Left ventricular dilatation or hypertrophy.
2. Regional wall motion abnormality.
3. Reduced ejection fraction.
4. Valvular thickening, calcification, stenosis, or regurgitation.
5. Right ventricular enlargement.
6. Pericardial effusion.
7. Intracardiac thrombus or mass.
8. Septal defects or congenital abnormalities.
🔶 Documentation

Save representative images and clips from standard views. Document measurements, chamber sizes, valve morphology, ventricular function, septal appearance, pericardial findings, and any abnormality. Include patient details, date, study type, and final impression in the report.
🔶 Clinical Applications

B-mode echocardiography is useful for cardiac screening, assessment of heart failure, evaluation of valve disease, detection of pericardial effusion, evaluation of cardiomyopathy, follow-up of congenital heart disease, and monitoring after cardiac procedures.
🔶 Advantages

1. Non-invasive and safe.
2. Real-time cardiac imaging.
3. No ionizing radiation.
4. Portable and widely available.
5. Useful for bedside evaluation.
6. Allows assessment of anatomy and function.
🔶 Limitations

Image quality may be limited by obesity, lung interference, chest wall deformity, poor acoustic window, tachycardia, patient movement, or inability to position the patient properly. Some lesions may require Doppler, contrast echocardiography, CT, MRI, or transesophageal echocardiography for further evaluation.
🔶 Scanning Technique

A-Basic Views of B-Mode
1. Parasternal Left Ventricular Long-Axis View PLVLA
2. Parasternal Aorta Short-Axis View At the Aortic Valve Level
3. Parasternal Aorta Short-Axis View Main Pulmonary Artery Long-Axis
4. Parasternal Left Ventricular Short-Axis View Mitral Valve Annulus Level
5. Parasternal Left Ventricular Short-Axis View Mitral Valve Level
6. Parasternal Left Ventricular Short-Axis View Mitral Valve Chordae Tendineae Level
7. Parasternal Left Ventricular Short-Axis View Mitral Valve Papillary Muscle Level
8. Left Ventricular Apical Level Short-Axis View
9. Parasternal Four-Chamber View
10. Apical Four-Chamber View
11. Parasternal Right Ventricular Outflow Tract Long-Axis View (1)
12. Apical Left-Heart Two-Chamber View
13. Apical Right-Heart Two-Chamber View
14. Parasternal Descending Aorta Long (Short)-Axis View
15. Coronary Sinus View
16. Long-Axis View of the Left Ventricular Right Anterior-Oblique Position
17. Long-Axis View of the Left Ventricular Apex Parasternal
18. Apical Five-Chamber View
19. Short-Axis View of the Inferior Vena Cava
20. Inferior Vena Cava Long (Short)-Axis View
21. Left Parasternal Right Ventricular Outflow Tract Long-Axis View (2)
22. Left Anterior Oblique Position Left Ventricular Apical Three-Chamber View
23. Subxiphoid Four-Chamber View
24. Subxiphoid Two-Atrium View
25. Subxiphoid Aortic Ventricular View
26. Subxiphoid Inferior Vena Cava Long-Axis View
27. Subxiphoid Ventricular Short-Axis View
28. Suprasternal Aortic Arch Short-Axis View
29. Suprasternal Superior Vena Cava Long-Axis View
30. Suprasternal Aortic Arch Short-Axis View
31. Main Pulmonary Artery Long-Axis View Subxiphoid
32. Transesophageal Two-Atrium View
33. Transesophageal Left Atrial Appendage View
34. Transesophageal Aortic Root Long-Axis View
B-Basic Tracings of M-Mode
1. Parasternal Left Ventricular Long-Axis View M-Mode, Echo Pattern of Heart Base (Aortic Root)
2. Parasternal Left Ventricular Long-Axis View M-Mode, Echo Pattern of Mitral Valve
3. Parasternal Left Ventricular Long-Axis View M-Mode, Echo Pattern of Left Ventricle
4. Great Artery Short-Axis View M-Mode Scan at Pulmonary Valve Level
5. Great Artery Short-Axis View M-Mode Scan at Aortic Valve Level

C-Spectral Doppler and Color Doppler Flow Imaging
1. Spectral Doppler of Mitral Valve Orifice Blood Flow
2. Color Doppler Flow Image of the Mitral Valve Orifice
3. Spectral Doppler of Tricuspid Valve Orifice Blood Flow
4. Tricuspid Valve Orifice Color Doppler Flow Mapping
5. Color Flow Mapping
6. Color Doppler Flow Mapping of the Pulmonary Artery Orifice

D-Pulsed-Wave (PW) Spectral Doppler
1. Apical Four-Chamber View Mitral Valve Inflow
2. Apical Four-Chamber View Tricuspid Valve Inflow
3. Apical Five-Chamber View Left Ventricular Outflow Tract (LVOT)
4. Parasternal Short-Axis View Right Ventricular Outflow Tract (RVOT)
5. Parasternal Short-Axis View Pulmonary Valve Outflow
6. Apical Five-Chamber View Aortic Valve Flow
7. Apical Four-Chamber View Pulmonary Vein Flow
8. Subcostal View Hepatic Vein Flow
9. Subcostal View Inferior Vena Cava (IVC) Flow
10. Suprasternal Notch View Descending Thoracic Aorta Flow
11. Apical Four-Chamber View Left Atrial Appendage Flow
12. Parasternal Long-Axis View Ascending Aortic Flow

E-Continuous-Wave (CW) Spectral Doppler
1. Apical Five-Chamber View Aortic Valve CW Doppler
2. Apical Five-Chamber View Left Ventricular Outflow Tract (LVOT) CW Doppler
3. Apical Four-Chamber View Mitral Regurgitation CW Doppler
4. Apical Four-Chamber View Tricuspid Regurgitation CW Doppler
5. Parasternal Short-Axis View Pulmonary Valve CW Doppler
6. Parasternal Short-Axis View Pulmonary Regurgitation CW Doppler
7. Apical Three-Chamber View Aortic Regurgitation CW Doppler
8. Apical Five-Chamber View Aortic Stenosis CW Doppler
9. Apical Four-Chamber View Mitral Stenosis CW Doppler
10. Parasternal Short-Axis View Pulmonary Stenosis CW Doppler

F-Power Doppler Imaging (PDI)
1. Power Doppler of Mitral Valve Blood Flow
2. Power Doppler of Tricuspid Valve Blood Flow
3. Power Doppler of Aortic Valve Blood Flow
4. Power Doppler of Pulmonary Valve Blood Flow
5. Power Doppler of Left Ventricular Outflow Tract (LVOT)
6. Power Doppler of Right Ventricular Outflow Tract (RVOT)
7. Power Doppler of Pulmonary Vein Flow
8. Power Doppler of Hepatic Vein Flow
9. Power Doppler of Inferior Vena Cava (IVC)
10. Power Doppler of Descending Thoracic Aorta

SonoAcademy Digital MCQ Examination

Topic: Basic Views of B-Mode Echocardiography

Total Questions: 10 | Total Marks: 10 | Time: 30 Minutes

Instruction: Enter your details, start the exam, answer all questions, and download your PDF marksheet after submission.

Exam Result

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Topic: Basic Views of B-Mode Echocardiography

Total Marks: 10

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Thursday, 25 June 2026

Foley Catheter with Negative bladder swirl sign

Foley Catheter Negative bladder swirl sign - SonoAcademy
📄 SonoAcademy

Foley Catheter
Negative bladder swirl sign

Ultrasound confirmation of correct urinary Foley catheter position and catheter patency

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Swirl Sign

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Saline Test

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USG Report

Positive Bladder Swirl Sign USG

Negative Bladder Swirl Sign refers to absence of mobile echogenic swirling echoes or turbulence within the urinary bladder lumen during real-time ultrasound after gentle saline instillation through a Foley catheter. It may suggest that the catheter tip is not correctly positioned inside the bladder, the catheter is blocked, kinked, or not patent, and catheter position should be reassessed.

Positive Bladder Swirl Sign Image 2 Catheter Balloon in Bladder
Ultrasound Features of Positive Bladder Swirl Sign:

Main Finding:
FINDINGS: Real-time ultrasound demonstrates no mobile echogenic swirling echoes within the urinary bladder lumen following gentle saline instillation through the urinary catheter. No sonographic evidence of intravesical entry of the instilled fluid is identified.
CONCLUSION: Negative bladder swirl sign.
RECOMMENDATION: Findings suggest possible malposition, obstruction, kinking, or occlusion of the urinary catheter. Correlate clinically and consider catheter repositioning, flushing, or replacement as indicated.
Bladder Lumen: Adequately distended or partially distended urinary bladder.
Catheter Tip / Balloon: Catheter balloon/tip may be visualized within or adjacent to the bladder; position should be carefully assessed.
Swirling Echoes: No mobile echogenic swirling echoes are seen within the bladder lumen following gentle saline injection through the urinary catheter.
Color Doppler: Not mandatory; grayscale real-time visualization is usually sufficient.
Perivesical Region: Evaluate for possible extravesical fluid collection if catheter malposition or leakage is suspected.
Key Diagnostic Clue: Absence of echogenic swirling movement inside the bladder after saline flush suggests that the instilled fluid is not entering the bladder lumen, raising suspicion of catheter malposition, obstruction, kinking, or occlusion.
Short Report Line:
Negative bladder swirl sign is noted following saline instillation through the urinary catheter, suggesting absent intravesical flow of instilled saline. Correlate with catheter position and patency.

Detailed Report Line:
Real-time ultrasound demonstrates no mobile echogenic swirling turbulence within the urinary bladder lumen following gentle saline instillation through the Foley catheter. The catheter balloon/tip position should be carefully evaluated. No definite intravesical entry of the instilled saline is demonstrated. Findings are suspicious for catheter malposition, obstruction, kinking, or occlusion. Clinical correlation with catheter assessment and repositioning or replacement is recommended.
Technique / Evaluation of Negative Bladder Swirl Sign:

1. Scan the suprapubic region in transverse and longitudinal planes.
2. Confirm adequate bladder filling and identify the urinary bladder lumen and catheter balloon/tip if visible.
3. Attach a sterile saline syringe to the catheter sampling/irrigation port according to local protocol.
4. Gently instill a small amount of sterile saline while continuously observing the bladder in real time.
5. If no mobile echogenic swirling echoes are seen within the bladder lumen, document a negative bladder swirl sign.
6. Assess the catheter balloon/tip position for possible malposition or incomplete intravesical placement.
7. Exclude common causes of a false-negative study such as an underdistended bladder, catheter obstruction, kinking, poor acoustic window, or inadequate saline instillation.
8. Evaluate the perivesical region for possible extravesical saline leakage if catheter perforation or malposition is suspected.
9. Correlate with urine drainage, catheter function, and the patient's clinical status.
10. If uncertainty remains, reposition or flush the catheter, repeat the ultrasound examination, or replace the catheter as clinically indicated.
Differential / Causes of Negative Bladder Swirl Sign:

Catheter Malposition:
FINDINGS: Catheter balloon is not confidently visualized within the urinary bladder lumen. No intravesical swirling echoes are seen following saline instillation. The bladder may remain distended.
CONCLUSION: Findings are suspicious for incorrect catheter position.
RECOMMENDATION: Reassess catheter position and reposition or replace the catheter if clinically indicated.
Blocked or Kinked Catheter:
FINDINGS: Distended urinary bladder with absent intravesical swirling echoes during saline flush and poor urine drainage.
CONCLUSION: Findings suggest catheter obstruction or kinking.
RECOMMENDATION: Flush the catheter if appropriate or replace the catheter. Consider urology consultation if obstruction persists.
Extravesical Catheter / False Passage:
FINDINGS: No intravesical swirling echoes are identified. Catheter balloon may lie outside the bladder with possible perivesical fluid collection.
CONCLUSION: Extravesical catheter position or urethral injury cannot be excluded.
RECOMMENDATION: Stop further forceful instillation and obtain urgent clinical and urological assessment.
Key Point: Absence of intravesical swirling after saline instillation should prompt evaluation for catheter malposition, obstruction, inadequate bladder filling, poor acoustic window, or technical factors before concluding catheter malfunction.
Important Reporting Points — Negative Bladder Swirl Sign:

1. Mention bladder distension status.
2. Describe catheter balloon/tip position if visualized.
3. State that saline instillation was performed under real-time ultrasound guidance.
4. Clearly document absence of intravesical swirling echoes.
5. Comment on possible catheter obstruction, kinking, or malposition if suspected.
6. Mention presence or absence of extravesical fluid collection.
7. Describe any bladder wall abnormality, clot, debris, or calculus.
8. Mention residual bladder distension if clinically relevant.
9. State any limitation such as underfilled bladder, bowel gas, obesity, or poor acoustic window.
10. Recommend catheter reassessment or replacement if findings remain suspicious.
FINDINGS:
Urinary bladder is visualized on suprapubic ultrasound. Following gentle saline instillation through the Foley catheter, no mobile echogenic swirling echoes are demonstrated within the bladder lumen. Catheter balloon/tip position should be carefully assessed. No definite intravesical entry of instilled saline is demonstrated. No significant extravesical fluid collection is identified unless otherwise described.

IMPRESSION:
Negative bladder swirl sign. Findings are suspicious for catheter malposition, obstruction, kinking, or non-functioning catheter. Correlate clinically.

RECOMMENDATION:
Assess catheter position and patency. Consider flushing, repositioning, replacement, or urological review as clinically indicated.

LIMITATION:
Assessment may be limited by inadequate bladder distension, bowel gas, obesity, patient discomfort, or suboptimal visualization of the catheter balloon/tip.
Case Study

Patient: Adult patient with poor urine drainage despite Foley catheter placement.

Ultrasound Findings: Urinary bladder is moderately distended. Following gentle saline instillation through the Foley catheter, no echogenic swirling echoes are visualized within the bladder lumen. Catheter balloon is not confidently identified within the bladder. No definite intravesical saline flow is demonstrated.

Diagnosis: Negative Bladder Swirl Sign.

Teaching Point: A negative bladder swirl sign does not by itself establish catheter failure, but it should prompt evaluation for catheter malposition, obstruction, kinking, inadequate bladder filling, or technical limitations. Clinical correlation and repeat assessment after catheter repositioning or replacement may be required.

SonoAcademy Digital MCQ Examination

Topic: Positive Bladder Swirl Sign

Total Questions: 10 | Total Marks: 10 | Time: 30 Minutes

Instruction: Enter your details, start the exam, answer all questions, and download your PDF marksheet after submission.

Exam Result

Name:

Email / Mobile:

Topic: Positive Bladder Swirl Sign

Total Marks: 10

Obtained Marks:

Percentage: %

Status:

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Parasternal Left Ventricular Long-Axis View PLVLA (2D Echo )

2D Echo 📄 SonoAcademy Parasternal Left Ventricular L...