| 7 MHz linear | intra operative |
| 7-8 MHz | transrectal prostate |
| 10 MHz linear | endoscopic ultrasound, during surgery insulinoma, thyroid, breast |
| 12 MHz linear | Achilles tendon |
| 5 MHz curved | to evaluate GB, pancreas, spleen, liver |
| 5 MHz linear with short focus | for evaluation of acute appendicitis |
| 13 mm | cutoff for portal vein enlargement |
| >10 mm | normal renal cortex |
| 6 mm (7 mm) | appendix diameter normal limit |
| 3-5 mm | normal average gut wall |
| 2 mm | normal pancreatic duct limit |
| 10-12Cm (9 -14 ) | normal kidney length |
| 3 mm | gallbladder wall normal limit |
| 8-12 hour | for gallbladder scan preparation |
| 60 degree | or less accurate velocity measurement |
| no other prep | only renal sonogram, moderated hydration |
| I. Liver (16%-24%) | |
| Inferior vena cava | three hepatic vein drain into |
| Kupper cell | macrophage in liver |
| Middle hepatic vein | the left medial segment separate form the right anterior segment |
| courses within the main lobar fissure | |
| Ligamentum venosum | the anterior border of the caudate lobe |
| the left of ligamentum venosum mass in the left lobe | |
| Ligamentum teres | the presence of a recannalized paraumbilical |
| divide into medial and lateral segment in the left lobe | |
| caudal border of the lest portal vein | |
| Recannalized paraumbilical | sagittal subcostal view through left lobe at the ligamentum teres |
| Blood supply of Liver | Portal vein and hepatic artery |
| Reidel's lobe | the inferior aspect of the right lobe, usually shown in slender female |
| Hepatic Vs portal vein | the portal veins are accompanied by branches of the biliary tree and hepatic artery |
| Grisson's capsule | surrounding the liver |
| Hepatic vein | course interlobar and intersegmental within the liver |
| 3 hepatic vein and IVC view | subcostal oblique the probe angle superiorly and patient's right side |
| High liver patient or dome | scan the patient in deep inspiration with superior angle |
| High frequency transducer | can detect posterior shadow and enhancement |
| Hepatocellular carcinoma | associated with serum alpha-fetoprotein |
| most commonly associated with invasion of the portal vein | |
| GGT and alkaline phosphates | elevation of both them indicates the source of the elevated alkaline phosphates is the liver |
| Liver function | GGT, AST, direct bilirubin, indirect bilirubin …… |
| Hepatic adenoma | oral contraceptive, hypoechoic mass, solid |
| Fatty liver(focal) | diffuse increase echogenicity with focal hypoechoic area |
| most commonly found in anterior to porta vein at the porta hepatis | |
| Fatty liver | may caused by obesity, diffuse or focal, rapid change with time, increase attenuation |
| hepatomegaly, echogenicity, decrease vascularity | |
| Liver cirrhosis | increased risk for hepatocellular carcinoma |
| surface nodularity, shrunken right lobe, altered echo texture, ascites | |
| need to evaluate the hepatic vein and IVC with color Doppler to confirm patency | |
| associated with portal hypertension, splenomegaly | |
| irregularity of the surface, a nodular liver, regenerating nodule | |
| luminal narrowing of the hepatic vein, high velocities through the strictures | |
| Right side heart failure | enlargement of the hepatic vein and inferior vena cava |
| Hepatomegaly | rounding of inferior border, longitudinal right lobe exceeding 15.5 cm |
| extension of the right lobe inferior to the lower pole of the right kidney | |
| increased anteroposterior measurement of the right lobe | |
| Cavernous hemangioma | single homogeneous hyperechoic , small, well-define |
| most common benign tumor in the liver, consist of vascular network | |
| more common in women than men, usually asymptomic | |
| Liver metastatic | single hypoechoic, multiple hyperechoic, mixed echogenicity, cystic masses |
| Liver cyst | thin wall, anechoic, increase through transmission, posterior acoustic enhancement |
| Hemorrhagic cyst | well-define mass with smooth wall, homogeneous low level echo, no Doppler signal |
| Hepatitis | fever, abnormal liver function, pain |
| decreased echogenicity, GB wall thickened, thick echogenic bands around portal vein | |
| Hydatid disease | infestation by parasite, sheep and cattle |
| Kaposi's sarcoma | associated with AIDS patient |
| Meta from adenoma of colon | markedly heterogeneous, numerous calcified lesions |
| Meta from lung ca | bull's eye, target lesion, anterior right lobe |
| Focal nodular hyperplasia(FNH) | second most common liver mass, a well define solitary mass, prominent vessels within scar |
| Budd-chiari syndrome | sudden onset ascites and hepatomegaly, pain |
| need Doppler to determine patency of the portal and hepatic venous system | |
| may seen biloma, hematoma, located ascites, abscess | |
| Liver transplantation | complication: malignant, hepatic artery thrombosis, portal thrombosis, pseudoaneurysm |
| biliary sludge, portal stenosis | |
| should be evaluate IVC, portal vein, hepatic artery, bile duct | |
| rejection can not detected by ultrasound, cholecystitis can not exist(excise) | |
| Portal hypertension | hepatofugal sign, spleen enlarged, a recannalized paraumbilical vein |
| should be evaluate presence of portosystemic collaterals | |
| ETOH alcohol abuse and cirrhosis, not associated with cyst | |
| splenic and retroperitoneal varices, need color Doppler | |
| Abscess | a large, round, homogeneous, adjacent to the capsule |
| TIPS | transjugular intrahepatic portosystemic shunt, portal vein and hepatic vein |
| Coronary vein | portal hypertension, left gastric, spleen, esophageal |
| a sagittal view of the splenic vein near midline | |
| Porta hepatis | cavernous transformation, portal vein thrombosis |
| II. Gallbladder and Biliary Tree (10%-18%) | |
| Interlobar hepatic fissure | anatomic landmark to identify the gallbladder = main lobar fissure |
| Phrygian cap | the fundus of gallbladder folded |
| Gallbladder artifact | reverberation, side lobe, slice thickness …… |
| Cholelithiasis | Gall stone |
| Choledocholithiasis | stones within the common bile duct, may be post cholecystectomy |
| GB wall thickness | associated with inflammation, hepatic dysfunction, heart failure, GB wall varice |
| not associated with malignant ascites | |
| Porcelain gallbladder | contain varying calcification, increase risk of carcinoma |
| CBD location | posterior and slightly lateral to the pancreas head |
| junction of the cystic duct and common hepatic duct | |
| is anterior to the hepatic artery and portal vein | |
| is posterior to head of pancreas | |
| Acute cholecystitis | most common cause is calculus obstruction neck or cystic duct |
| nausea, vomiting, epigastric pain, right upper quadrant pain | |
| associated with pancreatitis, GB perforation, gangrenous cholecystitis, emphysematous | |
| need to evaluate cystic artery(feed GB wall, a branch of right hepatic artery) | |
| Emphysematous cholecystitis | gas forming bacteria, common in male diabetics, surgical emergency |
| ring down artifact, nondependent hyperechoic foci, bright echo in the GB wall | |
| Murphy's sign | tenderness with probe pressure |
| Pancreas head mass | dilated, nontender gallbladder |
| Hydropic gallbladder | GB measured over 5cm (fasting) |
| choledocholithiasis, pancreatic carcinoma, chronic pancreatitis with stricture formation | |
| Bile stasis (sludge) | not thickened wall, low-level echo |
| Tumefactive sludge | an avascular mass with low-level echoes |
| Adenomyomatosis | a comet tail, V-shape reverberation, form of the hyperplastic cholesystoses |
| associated with Rokitansky-Aschoff sinus | |
| GB perforation | thick wall and adjacent compiles fluid collection, commonly multiparous woman |
| GB carcinoma | hypervascularity, multiple stones, asymmetric wall thickness, may detected liver meta |
| a mass replacing gallbladder | |
| Intra hepatic biliary system | identify below intrahepatic portal vein |
| Pneumobilia | air in the bile duct |
| Differentiate bile Vs vein, artery | with color Doppler, bile duct demonstrate irregular and tortuous walls |
| Bile duct wall thickening | sclerosing cholangitis, pancreatitis, choledocholithiasis, cholangiocarcinoma |
| Choledochal cyst | cystic dilatation of the common bile duct |
| Cholecintigraphy | Tc99m most accurate test for acute cholecystitis |
| Cholecystokinin | associate with GB contraction, from duodenum |
| Pancreatitis | complication of stone impacted in the distal CBD |
| Cholangiocarcinoma | associated with dilatation of the biliary tree |
| located in an intrahepatic or extra hepatic bile duct | |
| Sickle cell anemia | GB wall thickening, check pericholecystic fluid |
| Identificated GB | interlobar fissure, wall-echo shadow sign, bowel dirty), stone clean) |
| Hyperplastic cholecystoses | is benign tumor |
| III. Pancreas (6%-14%) | |
| Uncinate process | inner medial of pancreas head |
| Pancreas view | midline oblique left side of probe slightly caudal to the right side |
| Wirsung duct | the main pancreatic duct |
| Santorini duct | the accessory pancreatic duct |
| Pancreatic divisum | the two pancreatic ducts have not fused |
| Head of pancreas | anterior aspect of head = gastroduodenal artery |
| posterior aspect of head = common bile duct, posterior border = IVC | |
| coursing transversely at the level of the upper pancreas head = left renal vein | |
| Neck of pancreas | portal-splenic confluence is a prominent vessel just posterior to the pancreatic neck |
| superior mesenteric artery is located posterior to the neck | |
| Tail of pancreas | contact with left kidney, splenic flexure, spleen |
| Pancreas Doppler | improve detestability of possible pseudoaneurysm |
| Adenocarcinoma | most commonly occurring malignant tumor of pancreas |
| most common malignant tumor of the gastrointestinal tract | |
| most common appearance is hypoechoic mass | |
| associated with Lymphadenopathy and liver metastasis | |
| Pancreatic cancer risk | smoking, high fat diet, diabetes, chronic pancreatitis, peptic ulcer, cholecystectomy |
| exposure Benzedrine, gasoline derivatives | |
| Chronic pancreatitis | associated with alcohol abuse, a hyperechoic mass, dilatation pancreatic and CBD |
| diffuse calcification, heterogeneous echo texture | |
| Acute pancreatitis | increase pancreas enzyme and white blood cell count, |
| most common cause is calculus obstruction pancreatic duct by biliary calculi > alcohol abuse | |
| Wipple procedure | the remove of GB, CBD, part of duodenum and pancreatic head |
| CT | most accurate in staging pancreatic adenocarcinoma |
| Islet sell tumor | is endocrine tumor |
| Complications of pancreatitis | pseudoaneurysm, pseudocyst, plegmon, abscess, ascites, necrosis, biliary obstruction |
| gastrointestinal hemorrhage, hydronephrosis(ureteral obstruction) | |
| Pancreas transplant | the patient probably have type I diabetes mellitus, look for iliac fossa |
| rejection = high-resistance Doppler signal, heterogeneous parenchyma | |
| Phlegmon | a nonencapsulated collection of necrotic and edematous peripancreatic tissue |
| Pseudocyst | may be associated with acute or chronic pancreatitis, pacreatic cancer |
| may be well-define wall, anechoic, low-level echoes, internal septations | |
| Insulinoma | small, hypoechoic, located tail?, obese |
| Celiac trunk | superior border of the pancreas |
| go through splenic, left gastric, common hepatic artery | |
| Superior mesenteric vein | coursing anterior to the uncinate process |
| supplies the small intestine, right colon and most of the transverse colon | |
| Gastroduodenal artery | tubular structure coursing cephalocaudad anterior to pancreas |
| has a caudal course, anterior to the pancreatic head | |
| IV. Kidneys and Urinary Tract (16%-24%) | |
| Systemic lupus erythemotosus | hyper echoic |
| Left renal vein | is longer than right renal vein, anterior to the aorta |
| posterior to the superior mesenteric artery and anterior to the aorta | |
| Right renal artery | Posterior to the inferior vena cava, right renal vein lies anterior to the renal artery |
| False hydronephrosis | distended bladder, large extrarenal pelvis, parapelvic cyst, prominent hilar vessels |
| Papilloma | benign in bladder by pappilloma virus |
| Horseshoe kidney | right and left are attached at their lower pole, the isthmus located anterior abdominal aorta |
| Angiomyolipoma | a speed propagation artifact, high-fat content |
| a solid, hyperechoic mass with tuberous sclerosis | |
| Dromedary hump | thickening of renal cortex |
| Hypertrophy | Nephrectomy, renal agenesis, renal hyperplasia, renal atrophy (compensatory) |
| Central sinus | highly echogenic compare to renal cortex |
| Renal cyst | anechoic, acoustic enhancement, define smooth wall, round or ovoid shape |
| 50% of people over age 50 | |
| post biopsy and discover a cystic mass = using color Doppler | |
| Hydronephrosis | ureteral stone, uterine fibroid, ureteropelvic junction obstruction,ovarian mass,aorta aneurysm |
| not associated with acute pyelonephritis | |
| Column of Bertin pseudomass | compare with cortex(echogenicity), continuity with cortex, normal vascularity by C Doppler |
| lack of mass effect or splaying of central sinus fat | |
| Multicystic dysplastic kidney | multiple variably sized cysts, nonmedial location large cyst, no identify renal sinus |
| bright echogenic tissue interface cyst, not associated with dilatation of ureter | |
| usually diagnosed in early childhood or in utero | |
| Crossed renal ectopia | both kidney are on the same side of the abdomen |
| Wilm's tumor | most common in children aged 2-5 |
| Renal sinus | fat, calyce, infudibuli of the collecting system, vessels |
| Uretral Jet | periodic ureteral jet is normality, determine if a ureter is obstructed |
| in the examine the urinary bladder with color Doppler | |
| ureteral orifices are located base of the trigone along posterior aspect | |
| Polycystic kidney | hypertension and impaired renal function, too numerous cyst, enlarged kidney |
| may be 30% liver cyst, may be complicated bleeding infection, bilateral, progressive failure | |
| Evaluation of renal mass | extension of tumor into renal vein, liver metastasis, search for retroperitoneal adenophathy |
| Ureteropelvic junction obstruction | pelvicaliectasis to the level of the junction of the renal pelvis and ureter |
| Acute pyelonephritis | most common appearance is normal |
| may enlargement, compression of sinus, alteration texture, hypoechogenicity | |
| Main renal artery | Low resistance with forward flow throughout the cardiac cycle |
| Muscular hypertrophy | bladder outlet obstruction and thickening bladder wall |
| Chronic renal disease | small hyperechoic kidney, dialysis, multiple cyst of vary sizes. |
| Nephrocalcinosis | highly echogenic renal pyramid with or without posterior acoustic shadowing |
| Ureterocele | a small round cystic into urinary bladder |
| Transitional cell carcinoma | with hydronephrosis, a mass within the urinary bladder |
| irregular thickening of bladder wall, dilated ureter | |
| Lymphocele | post renal transplant, a fluid collection with septation, internal debis adjacent to the kidney |
| Interlobar artery(in intrarenal) | coursing alongside the renal pyramids |
| Renal lymphoma | multiple, bilateral, hyperchoic masses in enlarged kidney |
| Arcuate artery | coursing on top of the renal pyramid and give rise to the tiny intralobular artery |
| Morrison's pouch | the space between the liver and right kidney |
| Renal artery stenosis | Doppler renal study for uncontrolled hypertension |
| to rule out renal artery stenosis, compare with renal artery and abdominal aorta | |
| 60% or greater, a ratio 3.5 or greater is considered abnormal | |
| SMA is immediately superior to origin of the renal arteries | |
| damped with decrease diastolic flow | |
| the normal waveform of the main renal artery is Low resistance | |
| Resistive index | 0.7 or less is normal, RI =1 indicates a diastolic flow of 0 |
| if RI = 1, chronic renal disease, renal vein thrombosis, renal obstruction | |
| measure to look for rejection in a renal transplant | |
| Pyelonephritis | an ascending urinary tract infection |
| Chronic renal artery occlusion | in a smaller than the other side, echogenic |
| Acute renal artery occulusion | may show no abnormality |
| Kidney Doppler | posterior oblique, coronal view through posterior axiliary line |
| inadequate fill in intrarenal vasculature = decrease pulse repetition frequency | |
| Atypical cyst | internal septation, wall calcification, internal echo, irregular walls |
| Renal cell carcinoma | most common solid renal mass, most common renal tumor |
| Emphysematous pyelonephritis | multiple echogenic foci within the renal sinus or parenchyma with dirty acoustic shadow |
| Medullary nephrocalcinosis | calcified pyramids |
| Subcapsular hematoma | trauma, perirenal fluid collection that flattens the underlying renal contour |
| Acute tubular necrosis | the most common cause of acute renal failure |
| Post renal transplant | volume may increase 5-15% in the first 2weeks |
| renal artery is usually amastomesed to external iliac artery | |
| V. Scrotum (3%-7%) | |
| Mediastinum testis | Prominent echogenic linear echo in the midline of the testis |
| Orchitis | inflammation of testicle, hyperemic flow on color Doppler |
| most common associated with a large complex hydrocele | |
| hyprechoic testis, enlargement testis, thickened scrotal wall | |
| Seminoma | the most common germ cell testicular tumor |
| hyprechoic, well demarcated margins, sometimes multi focal, homogenous texture | |
| Torsion | bell clapper deformality, do not detect flow with Doppler |
| Testicular artery | branch from abdominal aorta, connect to capsular artery, low resistance |
| a common anatomic variant, opposite direction of the centripetal arteries | |
| enters the testicular parenchyma at the mediastinum testis, a large vein frequently accompany | |
| Testicular parenchyma artery | Low resistance |
| Spermatic cord | Vas deferns, testicular artery, cremasteric artery, deferential artery within spermatic cord |
| Centripetal artery | the intertesticular arteries that arise from the capsular artery |
| course within testicular parenchyma | |
| Left testicular vein | drain into left renal vein |
| Sensitivity slow flow | Low PRF, Low filter, High gain, High packet size |
| Infertility work up | associated with varicocele |
| Hydroceles form | between the two layer of the tunica vaginals |
| Rete testis | mediastinum testis |
| Testicular malignancy | irregular shape of testis, intratesticular location of mass, not associated with hydrocele |
| Scrotal Doppler | epididymits orchitis Vs torsion |
| Hematocele | a large hydrocele with prominent internal echoes, trauma, pain, swelling |
| VI. Prostate (1%-2%) | |
| Rectum | posterior to the prostate gland |
| Peripheral zone | most likely involved with prostate cancer |
| Transition zone | most commonly involved with benign prostatic hypertrophy |
| Seminal vesicles | posterior and superior to the prostate gland |
| hypoechoic, symmetrical, irregularly shaped structure | |
| Transretal sonogram | (left) lateral decubitus, 7-8 MHz |
| rectal exam, high PSA, guidance for biopsy, monitor treatment prostate cancer | |
| with color Doppler allow improved perception of pathologic vessels associated with cancer | |
| the rectum is shown at bottom of the screen | |
| Prostatism | difficult initiation of voiding, nocturia, small stream |
| Prostate cancer | Hypoechoic, Isoechoic, hyperechoic lesion, looking for unknown metastasis |
| Transrectal biopsy | cleansing enema, antibiotics prior and following the exam |
| Zonal anatomy | most commonly used to describe the prostate |
| Prostaticovesical arteries | supply from internal iliac artery |
| Benign prostatic hyperplasia | enlarged prostate gland which may be diffuse or focal |
| Ejaculatory duct cyst | may be associated with infertility |
| Abscess | acute prostatitis, anechoic mass within prostate |
| VII. Spleen (1%-5%) | |
| Contacted with spleen | left hemidiaphragm, stomach, pancreas, splenic flexure |
| Long axis spleen | intercostal coronal view with patient supine |
| Moderate splenomegaly | portal hypertension, infection, AIDS, |
| Markly splenomegaly | leukemia, lymphoma, myelofibrosis |
| Accessory spleen | at the splenic hilum that is homogeneous and isoechoic with the spleen |
| Splenic infarction | a hypoechoic, wedge shaped lesion, evaluate the lesion with color Doppler |
| Portal hypertension | moderate splenomegaly, dilated, tortuous vessels at the splenic hilum |
| need to evaluate the liver and portal vein | |
| Splenic vein | detect at the splenic hilum, drain into the portal vein, join SMV underneath pancreatic neck |
| Pancreatic tail | is inferomedial to the spleen |
| Spleen echogenicity | homogeneous with mid to low level echogenicity |
| Spleen | located intraperitoneal, 12Cm length, fundus of stomach and the diaphragm, decrease |
| Pitfall | rib shadow, in hepatomegaly the left lobe, mass of pancreatic tail, enlarged lymph node |
| Histoplasmosis | multiple focal, bright echoic masses throughout the spleen |
| Recent trauma | laceration, subcapsular hematoma of the spleen, free fluid, perisplenic hematoma |
| past history calcified splenic cyst( nor a acute ) | |
| Metastasis in spleen | multiple hyperechoic masses from malignant melanoma |
| Splenic artery aneurysm | portal hypertension, splenomegaly, calcified ring at the splenic hilum |
| evaluate the area with color Doppler | |
| most commonly involved, in women (pregnancy) | |
| Splenic cyst | smooth border, anechoic, posterior acoustic enhancement, round shape |
| Splenic hemangioma | most common primary tumor of the spleen |
| VIII. Retroperitoneum (3%-7%) | |
| Retroperitoneal located | kidney, pancreas, aorta, psoas muscles |
| Quadratus lumborum muscle | a striated, hypoechoic immediately posterior to both kidney, retrofacial space |
| Psoas muscle | a striated, posteromedial in relation to the kidney, retrofacial space |
| Perirenal space | kidney, adrenal gland, proximal ureter and perirenal fat |
| Para-aortic lymph node | several hypoechoic, slightly greater than 2cm, adjacent to the celiac trunk and SMA |
| Pancreatic pseudocyst | a fluid pocket in the left pararenal space, amylase |
| Retroperitoneal fibrosis | hypoechoic smooth margin, commonly involved abdominal aorta |
| Lymph node | need to measure of each lymph node |
| Pheochromocytoma | associated with adrenal glands |
| Adrenal gland | common site for metastasis from the lung |
| Right adrenal gland | posterior to the inferior vena cava, superomedial to upper kidney pole |
| lateral to crus of the diaphragm | |
| Left adrenal gland | lateral to the abdominal aorta and diaphragmatic crus |
| Lymphadenopathy | located splenic hilum, porta hepatis, renal hilum, para-aortic area |
| multiple hypoechoic nodules, surrounding the aorta and separating the mesenteric vessels | |
| Renal Vs adrenal | deep inspiration and expiration scan |
| Left adrenal pseudo mass | thickened diaphragmatic crus, accessory spleen, gastric diverticulum |
| retroperitoneal Lymphadenopathy | |
| Right diaphragmatic crus | posterior to the inferior vena cava and right renal artery |
| Nodal disease | greater than 1.0cm are considered to be abnormal |
| Lymphocele | a palpable mass, anechoic mass with multiple, around abdominal wall, following surgery |
| No solid organ space | posterior pararenal space, retrofascial space |
| Anterior pararenal space | most frequently involved with pseudocyst, a leaking abdominal aortic aneurysm |
| Cushing's disease | excessive production of ATCH from pituitary, associated with pituitary adenoma |
| IX. Abdominal Vascular (7%-15%) | |
| Portal vein thrombus | must evaluate superior mesenteric vein and splenic vein |
| Atherosclerosis | the most common cause of aortic aneurysm |
| Confluence portal and splenic | anterior to the uncinate process and posterior to the neck |
| Low flow detect | decrease PRF, increase gain, decrease incidence angle, decrease high pass filter |
| Abdominal aorta | normally tapers in diameter from its cranial to its caudal extent |
| Common iliac artery | divide into internal and external iliac artery |
| Abdominal bruit | vascular compromise involving the aorta or its branches |
| with chronic pancreatitis = pseudoaneurysm of hepatic or splenic artery | |
| MedianArcuateLigamentSyndrom | diaphragm lies anterior to the abdominal aorta just proximal to origin of celiac trunk |
| during both inspiration and expiration and in both the supine and upright | |
| Mesenteric artery Doppler | in a fasting High resistance |
| Common hepatic artery | proper hepatic artery and left gastric artery |
| Replace hepatic artery | from superior mesenteric artery |
| Chronic mesenteric ischemia | postprandial abdominal pain and weigh loss |
| celiac trunk, superior mesenteric and inferior mesenteric artery | |
| Portal venous system Doppler | mild undulating, low velocity |
| Aneurysm | aneurysm size is biggest risk factor for rupture, >3cm in any dimension |
| most common location of abdominal aortic aneurysm = infrarenal aorta | |
| evaluation of common iliac arteries, measure diameter, assessment intraluminal thrombus | |
| Aortic dissection | Mafan's syndrome, linear band throughout the length of the abdominal aorta relation cardiac |
| Hepatic vein Doppler | triphasic |
| Variceal hemorrhage | the most significant clinical consequence of portal hypertension |
| Portalveincavernous transformation | network of vessels replacing obliterated portal vein |
| Portal vein Vs Hepatic artery | the flow direction is same |
| Aortic graft | a pseudoaneurysm at the graft site wave form = high velocity, bidirectional |
| the graft site near a pulsating hematoma wave form prominent peak = neck of pseudoaneurysm | |
| Fusiform aortic aneurysm | dilatation with a gradual transition between the normal and abnormal segment |
| X. Gastrointestinal Tract (1%-5%) | |
| Gut layer five | inner mucosa(echogenic), deepmucosa(hypoechoic), submucosa(echogenic) |
| muscularis proria(hypoechoic), serosa(echogenic) | |
| Exophytic mass | perform compression sonography over the suspicious area |
| Gut mass color Doppler | differentiation between ischemic and inflammatory |
| Appearance of gut | target, asymmetric target, pseudokidney |
| Crohn's disease | gut wall thickening, strictures, creeping fat, increase vascularity, chronic diarrhea |
| Acute appendicitis | gradual and uniformly pressure with probe over the area of interest |
| diameter greater than or equal 6mm, noncompressible appendix | |
| there are no pathognomonic laboratory value for acute appendicitis | |
| Appendicolith | hyperechoic focus with posterior shadowing |
| Stomach Vs pathology mass | drink some water while imaging the suspicious area |
| Obstruction, Ileus | hypersecretion, may detect multiple dilated fluid-filled loop of bowl |
| Haustra | dilated loops of bowel in colon |
| Intussusceptions | dilated bowel with multiple concentric rings |
| Creeping fat | Crohn's disease, hyperechoic mass effect, thyroid-like appearance in adjacent to the bowel |
| Mucosa | the innermost lining of the gut, Outer most is serosa |
| Adventitia | the outer most connective tissue covering of any organ |
| XI. Neck (1%-3%) | |
| Sternohyoid and sternothyroid | strap muscle of the neck, located medial to the sternocleidomastoid and anterior of thyroid |
| Internal jugular vein | most lateral vessels, the most medial vessels are common carotid artery |
| Longus coli | posterior to each lobe of the thyroid |
| Thyroid nodule Doppler | to be sensitive in determining if a thyroid nodule is benign or malignant |
| Hashimoto's thyroiditis | diffuse enlargement of the thyroid with heterogeneous echo texture |
| hypoechoic thyroid, coarsened parenchymal echo texture | |
| Graves disease | an enlarged gland, markedly increased vascularity of both lobe |
| Parathyroid adenoma | associated with serum calcium |
| Hyperparathyroidism | usually caused by enlargement One parathyroid gland |
| Parathyroid hyperplasia | usually involved four parathyroids |
| Nodal malignancy in the neck | rounded lymph node, heterogeneous echo texture, intranodal calcification, absence echo hilum |
| Esophagus Vs nodule | swallow while scanning the area |
| Vertebral artery | courses through the transverse foramina of the cervical spine |
| Superior thyroid artery | is a branch of external carotid artery |
| Papillary carcinoma | the most common form of thyroid cancer |
| Subclavian artery | thyrocervical trunk arises from subclavian artery |
| Left common carotid artery | arises from aortic arch |
XII. Abdominal wall, superficial and muscular structures(1%-5%) |
|
| Baker's cyst | popliteal fossa, behind knee |
| Parotid gland | between the external auditory canal and the inferior edge of the mandible |
| Normal breast lymph node | small, ovoid with hypoechoic rim and echogenic hilum |
| Rectus sheath hematoma | mid abdominal wall |
| Lateral breast mass | opposite posterior oblique with arm abducted |
| Carotid body tumor | at the level of the carotid bifurcation between the internal and external carotid arteries |
| Malignancy of a solid mass | taller than wide, spiculation, angular margins, markedly hypoechoic solid lesion |
| Terminal ductal lobular unit | lobule with its terminal branch, short intralobular and longer extralobular duct |
| Breast cyst | smooth walls, sharp anterior and posterior borders, no internal echo, posterior enhancement |
| Breast mass in a radial plane | obtain images in a projection 90 degree to the original plane |
| Muscular trauma | on sagittal scan, oblique, parallel, echogenic fibers are seen against a hypoechoic background |
| Peripheral nerve | markedly hyperechoic structure with parallel internal linear echoes |
| Tendonitis | tendons are highly echogenic with a fibillar echotexture |
| vascularity, thickening tendon, decrease echo, blurred margins, calcification in chronic | |
| False hypoechogenicity tendon | oblique incidence of the beam to the tendons axis |
| Ganglion cyst | usually in a wrist nodule or occurs adjacent to a joint |
| Rotator cuff | shoulder real time exam |
| XIII. Instrumentation (1%-2%) | |
| Aliased wave form | the peak is cut off and shown below the base line, when sampling rate too low(PRF) |
| the peak systolic velocity will be underestimated | |
| should do to correct = increase PRF | |
| Quality control | monitor equipment performance |
| Biopsy during sonogram | image the needle at near perpendicular incidence |
| Color packet size | will increase the signal to noise ratio and result in a stronger signal |
| Frame rate | inverse field of view |
ARDMS Abdomen review 복부 초음파 시험 정리
