| 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 |
