Abdominal Ultrasound
Item Type Presentation
Authors Khan, Fiza; Smith, Kieko
DOI 10.13028/9qsg-dm98
Publisher eScholarship@UMassChan
Rights Copyright 2023 The Author(s).
Download date 17/10/2023 06:22:01
Link to Item http://hdl.handle.net/20.500.14038/51724
ABDOMINAL
ULTRASOUND
FIZA KHAN DO
KIEKO SMITH ARDMS
PREPARATION
• Patient position:
• Supine
• Left Lateral Decubitus
• Ultrasound transducer selection:
• Curvilinear
• Phased array
• Presets:
• Abdominal
• Penetration
• Harmonics
ULTRASOUND BASICS
LIVER ULTRASOUND
LIVER • Assess: Size, Texture, Echogenicity
ULTRASOUND
LIVER SIZE
• Cranio-caudal length
• <16cm
• Left hepatic tip
• Sharp vs. Blunted
LIVER ECHOGENICITY
LIVER CONTOUR/TEXTURE
LEFT LIVER LANDMARKS-
SAGGITAL •
•
Proximal Aorta
Upper IVC
• Caudate lobe
• Ligamentum Venosum
• Left hepatic vein
LEFT LIVER • lateral/medial
LANDMARKS - • Left portal vein
TRANSVERSE • superior/inferior
RIGHT LIVER
LANDMARKS-
SAGGITAL
RIGHT LIVER LANDMARKS- TRANSVERSE
LIVER VASCULATURE
LIVER VASCULATURE: PORTAL VEIN
Hepatofugal flow
Portal vein hypertension Cavernous Transformation
LIVER PATHOLOGY
Liver Echogenicity
Increased Decreased
Fatty infiltration Cirrhosis Acute hepatitis
• Starry sky
• Coarsened/ heterogenous
echotexture
• Lobar redistribution (EtOH)-
early
• Small liver with nodular
contours – chronic
LIVER PATHOLOGY
Liver Mass
Hyperechoic to
Hypoechoic heterogeneous
1. HCC
Single Multiple 2. Hepatic adenoma
3. Focal nodular
Hyperplasia
4. Hemangioma
DDx:
Simple/ Complex 1. Lymphoma
avascular 2. Micro abscesses
(target lesions)
3. Mets
Cyst Vascularity
No Yes
Hematoma Abscess/
met
ASCITES
Ascites
• Location:
• Dependent portion : hepatorenal recess (Morison pouch) and cul-de-sac
• Simple anechoic- transudative ascites, urine and bile
• Echogenic Particles Exudative ascites, hemorrhage, pus,
• Septation Malignant ascites, spilled GI contents
• Debris
• Mass- tumor vs abscess
• vascular flow- internal vs peripheral
GALLBLADDER ULTRASOUND
GALLBLADDER
CHOLELITHIASIS:
WALL-ECHO-
SHADOW
GALLBLADDER:
SONOGRAPHIC
MURPHY'S
SIGN
Must have the gallbladder in view
on the screen when pushing down
GALLBLADDER:
ACUTE
CHOLECYSTITIS
• Checklist:
• Gallbladder wall
thickening: >4mm
• Pericholecystic fluid
• Positive Murphy's
sign
GALLBLADDER
PATHOLOGY
CONT.
COMMON BILE
DUCT
• <6mm in AP diameter for
patients under 60 years
old
• Add 1mm per
decade after 60
BILIARY TREE PATHOLOGY
PANCREAS
ULTRASOUND
Pancreas
Pancreas
Increased Decreased
Fatty infiltration Chronic pancreatitis Acute pancreatitis
- Atrophic and fibrotic
- Calcification - ill-define margins
- Ductal dilation - Gallstone
- Dilated biliary tree
- Fluid accumulation
- Collection
ACUTE VS. CHRONIC PANCREATITIS
PANCREATIC HEAD
MASS
• A dilated pancreatic
duct is suspicious for
mass in the pancreatic
head
• >4mm at head
SPLEEN ULTRASOUND
• Knuckles to bed
• Splenomegaly
• >14cm
Spleen
• Normal anatomy
• Homogenous with smooth borders
• Size: length < 14cm and thickness < 6 cm
• Common Patholgy
• Complex cyst lesion Abscess or hematoma
• Multiple hypoechoic lesions lymphoma, micro-abscesses, and metastases
• Hypoechoic and anechoic subscapular lesion infract
SPLEEN PATHOLOGY
RENAL ULTRASOUND: Normal Anatomy
RENAL
ULTRASOUND:
NORMAL
VARIANTS
Renal Cysts:
A C D
E
CB
Non-obstructing renal
calculi
Renal masses
• Obstruction
• Key hydronephrosis (confirm with color Doppler)
• DDx: peri-pelvic cysts, multiple simple cysts in the renal sinus and extra-renal pelvis
• When filled with echogenic debris- pyonephrosis
• Asymmetrically elevated RI of acurate artery
HYDRONEPHROSIS
• Pyelonephritis
• Heterogenous appearing of the parenchyma and decrease blood flow on
doppler
What is the diagnosis?
• Diffuse renal Parenchymal Disease
• Increase echogenicity
Adrenal
Common adrenal pathology
Isoechoic Calcification Heterogenous hyperechoic
Hyperplasia- Pheochromocytoma Adrenal hemorrhage
Adrenal hemorrhage Adrenal myelolipoma
infectious/ mets/ Tumor
lymphoma Wolman disease
Adrenal adenoma
APPENDICITIS
• Findings in Acute
Appendicitis:
• Outer diameter greater
than 6-7 mm
• Non-compressible
• Lack of peristalsis
• Target Sign
REFERENCES
• https://www.pocus101.com/efast-ultrasound-exam-made-easy-step-by-step-guide/
• https://ultrasoundpaedia.com/liver-segments/
• https://www.cambridge.org/core/books/manual-of-emergency-and-critical-care-ultrasound/gallbladder-
ultrasound/B91ED0A3FCB4CC7FEB579241C253860E
• https://radiopaedia.org/cases/choledocholithiasis-32
• https://radiologykey.com/ultrasound-of-the-pancreas/
• https://link.springer.com/article/10.1007/s10396-019-00954-2/figures/2
• https://www.ultrasoundcases.info/pitfalls-5260/
• https://www.sciencedirect.com/science/article/pii/S1726490118301746
• Hansen KL, Nielsen MB, Ewertsen C. Ultrasonography of the Kidney: A Pictorial Review. Diagnostics. 2016; 6(1):2.
https://doi.org/10.3390/diagnostics6010002
• https://www.topdoctors.co.uk/medical-articles/can-a-kidney-disappear-a-guide-to-multicystic-dysplastic-kidney-mcdk
• https://www.frontiersin.org/articles/10.3389/fped.2020.00458/full
• https://www.thepocusatlas.com/new-blog/appendicitis
• https://www.ultrasoundcases.info/cases/abdomen-and-retroperitoneum/pancreas/acute-pancreatitis/
• https://www.ultrasoundcases.info/calcifications-5257/
• https://www.ultrasoundcases.info/cases/abdomen-and-retroperitoneum/spleen/splenic-infarcts/
• https://radiopaedia.org/cases/subcapsular-splenic-hematoma-1
