AnnaTorres

ultrasound.anatomy@wp.pl

ChairofAnatomy,DepartmentofDidac;csandMedicalSimula;on,imul.pl;www.csmlublin.pl

Overview of ultrasonography Ultrasound anatomy of the abdomen part 1

Noconflictofinterestdeclared

ChairofAnatomy,DepartmentofDidac;csandMedicalSimula;on,imul.pl;www.csmlublin.pl

Ultrasound anatomy of the abdomen

Basic physician tools … ?

WHYHERE…?

Rodríguezetal.WirelessUltrasoundGuidanceforFemoralVenousCannula;oninElectrophysiology:ImpactonSafety,Efficacy,andProceduralDelay.PacingClinElectrophysiol.2015

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Overview •  Basicphysicsandlanguageofultrasonography•  Mostcommonar;factsin2-dimensionalUSG•  EquipmentanddiversityofUSG•  UnderstandingscanningplanesandmeasurementsinUSG•  Anatomy:

•  Transverseepigastricscan–understandingtopography•  Largevesselsofabdomenandpelvis•  Pancreas•  Liver•  Hepatobiliaryductsandthegallbladder•  Spleen•  Smallandlargeintes;ne

•  Prac;calpart:iden;fyingorgans

Basic Physics

•  Ultrasound:•  acus;cwave>20000Hz•  abdominalsonography:3–5MHz•  Sonographicterms:

•  echogenicity•  hyperechogenic=bright•  hypoechogenic=dark•  anechoic=black

•  blood,urine,bile,cerebro-spinalfluid,exudate,ascites,amnio;cfluid,cys;clesions

Language of USG: Echogenicity

1

32

ArHfacts

•  donotcorrespondtorealstructures,i.e.donotrepresentarealacus;cinterfacewithregardtoshape,intensityorloca;on•  acus;cshadow:bones,gas,stones,foreignbody

•  echo-freeorhypoechogenicbehindtheinterface

•  lateralshadow•  acus;cenhancement•  reverbera;on

ArHfacts

Equipment

Diversity of USG methods

B-modeandM-mode

Color/Power/Spectral/Doppler

Diversity of USG methods

Dimensionalmodes

Diversity of USG methods

Contrast-enhancedultrasound

Hydrosonography

Diversity of USG methods

Elastographyisanoninvasivemethodinwhich;ssues;ffnesscanbeimagedasacolormaporshearwavevelocity.

Understanding scanning planes transverse scan

abdominalwall–anteriorsurface

rightsideofthebody

leAsideofthebody

Back–posteriorsurfaceofthebody

Understanding scanning planes sagiKal scan

Abdominalwall–anteriorsurface

Cephalic Caudal

Back–posteriorsurfaceofthebody

Epigastrium–transversescan

Epigastrium–saggitalscan

Pancreas•  transversescanthroughepigastrium

•  Importantlandmarks:

•  splenicveinliesposteriorly

•  beginningofportalveinsurroundedbytheheadofthepancreas

Pancreas•  S–shaped• Hypoechogenicwithhyperechogenicduct

•  Isoechogenicorhypoechogeniccomparingtoliver

•  Liesanteriorlytovertebralcollumn,aortaandIVC

• Diameters(AP):•  head25-30mm•  corpus<18mm•  tail25-30mm•  duct<2mm

Liver–leflobe•  Transversescanthroughtheepigastrium

IIIV

VIII

VII

Liver–rightlobeObliquesubcostalscan

II

IV

VIII

VII

Disney and the Liver: what do they have in common ???

HepaHc triad

Behervisibleoninspira;on

3roundanechoicstructures•  posteriorly–portalvein;normal<13mm

•  anteriorlyandonthelef–properhepa;cartery

•  anteriorlyandontheright–commonbileduct;normal<6-7mm(<9mmafercholecystectomy)

Livermeasurements:•  saggitalscaninmid-clavicular:<13-15cm

•  loweredgeofliverinrela;ontotherightkidney:itshouldfinishhalfwaydownthekidney.

GallbladderLoca;on:• withinmainlobarfissure

• ontherightside–rightlobeoftheliver

• onthelefside–quadratelobeoftheliver

•  anteriortopylorusofthestomach(1stpartoftheduodenum)

•  shape:•  ovalorpear-like•  elongated•  curved•  echo-freeinterior•  smoothwalls

•  measurements:•  lenght<100•  widht<40mm•  volume<100ml•  wallthickness<3mm

•  homogenousechogenicity•  smoothsubphreniccontour,wavedatthehilum

•  shape:•  longitudinaal:lunateorwedge-shaped

•  transverse:elip;c•  "invertedcomma"appearance

•  measurement:•  lenght<11-12(13)cm

•  thickness<4cm•  width<7cm

Spleen

•  Mul;lamellatedappearance

•  Alterna;nghyper-andhypoechoiclinesrepresentlayersofGIwall

Layers:•  Mucosa:echogenic•  Muscularismucosa:hypoechoic

•  Submucosa:echogenic,thethickest

•  Muscularispropria:hypoechoic

•  Serosa:echogenic

IntesLne

Normalwallthickness<2mm

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