During an echocardiogram, the technician places the ultrasound probe in the small notch at the base of your throat, called the suprasternal notch, to get a direct view of your aortic arch and surrounding blood vessels. This isn’t a separate test. It’s a standard part of a complete echocardiogram that gives the technician angles on structures they can’t see well from the chest alone.
What the Technician Sees From Your Neck
The suprasternal notch sits right between your collarbones at the top of your breastbone. When the probe is angled downward from this spot, it provides a clear window to the aortic arch, which is the curved section of your body’s largest blood vessel as it bends from your heart and heads down through your chest. From the chest views alone, this curve is partially hidden behind bone and lung tissue.
Depending on the angle, the technician can also see the right pulmonary artery (the vessel carrying blood to your right lung), the left atrium (the upper left chamber of your heart), the superior vena cava (the large vein returning blood from your upper body), and the smaller arteries that branch off the aorta toward your head and arms. A study of over 1,000 pediatric patients confirmed that this single probe position can image the entire aortic arch along with these branching vessels, making it one of the most information-dense views in the whole exam.
Why the Aortic Arch Matters
Your doctor may be looking for several things when the technician captures this view. The most common reason is to measure the size of the aorta. An enlarged or dilated aorta can signal an aneurysm, a weak spot in the vessel wall that could become dangerous if it grows. Research comparing ultrasound measurements taken from the suprasternal notch to CT scan measurements found the two methods agreed within about 0.6 millimeters on average for the aortic arch, making this a reliable and quick way to check aortic size without radiation.
This view is also used to look for coarctation of the aorta, a narrowing that restricts blood flow and raises blood pressure. It can detect abnormal blood flow patterns using Doppler, which translates the speed and direction of blood into color and sound. If blood is moving too fast through a section of the aorta, it suggests a narrowing. If it’s flowing in the wrong direction, it could indicate a leaky aortic valve.
The Neck View in Children
For pediatric echocardiograms, the suprasternal notch view is especially valuable. Children’s smaller chest walls actually make this window easier to obtain, and many congenital heart defects involve the exact structures visible from this position. Conditions like aortic arch interruption (where a section of the arch is missing entirely), hypoplastic left heart (an underdeveloped left side of the heart), and abnormal connections of the pulmonary veins all show up clearly from this angle.
In a large study of children ranging from one day old to 18 years, the suprasternal views consistently added information that the standard chest views missed. For evaluating whether too much or too little blood is reaching the lungs, or for spotting an extra vein draining into the wrong place, this view was often the deciding factor in the diagnosis.
How It Feels During the Exam
When the technician moves the probe to your neck, you’ll typically be asked to lie flat or slightly extend your neck by placing a small pillow under your shoulders. The probe presses into the soft notch at the base of your throat, which can feel mildly uncomfortable or cause a brief sensation of pressure. Some people find it triggers a mild urge to cough or swallow. This part of the exam usually lasts only a minute or two before the technician moves back to the chest.
Body size can affect how well this view works. In patients with severe obesity, overall echocardiogram image quality drops by nearly 40% compared to patients with a normal BMI, because extra tissue absorbs the ultrasound signal before it can reach the structures and bounce back. The suprasternal notch has less overlying tissue than the chest wall, which can sometimes make it a more reliable window in larger patients, though results vary.
This Is Not a Carotid Ultrasound
If you noticed the probe on your neck and wondered whether the technician was also checking your carotid arteries, that’s a different exam entirely. A carotid ultrasound focuses on the arteries running along the sides of your neck, looking for plaque buildup that could lead to a stroke. During an echocardiogram, the probe sits in the center of your neck at the base of your throat and is angled downward toward your heart and aorta. The two tests use similar equipment but examine completely different structures for different reasons.
Some people also wonder whether the technician is checking the veins in their neck. While the jugular veins are visible in this area and their pulsations can reflect pressure in the right side of the heart, a standard echocardiogram measures right heart pressure through other methods, primarily by using Doppler on a valve within the heart itself. The neck veins aren’t typically the focus during an echo, even though they happen to be nearby.