Double aorta artifact on ultrasound - Identification, mechanism, and correction

Artifacts are a common occurrence encountered in day-to-day practice by radiologists in all imaging modalities. Imaging artifacts encountered in ultrasonography may be due to physical limitations of ultrasound (USG) waves or the tissues in which USG wave travels, limitations in the detection and processing of echoes, or due to improper scanning technique. Some artifacts are observed commonly, while some are not, which, to the inexperienced eye, may cause confusion with definite pathologies during clinical practice. One such ultrasonographic artifact is the double aorta artifact, which gives the impression of the presence of two aortas or duplication of the aortic lumen. If unrecognized, unnecessary investigations may be carried out to rule out the presence of rare anomalies such as true duplication of the aortic lumen, aortic aneurysm, or dissection. Double aorta artifact usually occurs in thinly built individuals and is a result of the refraction of the USG waves at the interface of the rectus abdominus muscle and the fat underneath. This review article aims to describe with the support of schematic drawings and ultrasonographic images, the appearance of this artifact, the mechanism by which this artifact occurs, the steps that the radiologist must take to differentiate the artifact from actual pathology, and the steps taken to mitigate the artifact.