ultrasound of normal abdominal organs - helse bergen · ultrasound of normal abdominal organs geir...
TRANSCRIPT
1
Ultrasound of normal abdominal organs
Geir Folvik, MD
Division of Gastroenterology
Department of Medicine, Haukeland University Hospital
Bergen, Norway
30.11. 2015
2
Basic ultrasound imaging
ultrasound frequencies: from 3,5 to 5 MHz (up to 15 MHz)
high-frequency ultrasound gives a high spatial resolution, but reduced
penetration in depth
air, gas and bones: high reflection factor
attenuation of the ultrasound wave is caused by
– absorption, reflection, refraction and scattering
– fatty tissue gives a high absorption
3
Helping techniques
familiar with technical scanning variables
knobology
overnight fasting
full urinary bladder
oral water intake
respiration/ Valsalva
examination in both supine, sitting and standing positions
4
Systematic approach (6+)
5
Organ evaluation
size and shape
structure/ echogenicity
surface
ducts
blood vessels
6
Liver
– smooth surface
– fine structure and homogenous echogenicity » slightly hyperechogenic compared to renal cortex
– no focal lesions
– wedge shaped edges
– size blunt edges
liver below right costal margins/arc
size can be measured a.m. Kratzer
– segments
7
Liver
8
Liver
9
Liver –size a.m Kratzer
overnight fasting, supine and right arm behind head
max inspiration
largest craniocaudal diameter i right MCL
88,5% in a large cohort had a diameter <16 cm
– BMI
– hight
– sex
Kratzer et al. J Ultrasound Med 2003
10
Segments
2 lobes – right and left
8 segments: – lobus caudatus 1
– left lobe 2,3
– right lobe 4-8
ligamentum teres
ligamentum venosum
ligamentum falciforme
11
Segments
13
7
8
4
3
2
12
Liver
vv. hepaticae – run a dominantly straight course and divides in sharp angles
– anechoic walls
– typical flow pattern on Doppler (atrial contraction/ respiration)
v. porta – highly echogenic vessel walls
– divides in less sharp angles
– <13-15 mm?
13
Vv. hepaticae
14
Vv. hepaticae
15
Hepatic veins -flow
16
V. porta
17
V. porta
Normal portal and splenic vein
19
Gallbladder
Gallbladder (inter- and subcostal view) – after a night`s fast
– supine/ left lateral position/ sitting/ standing/ deep inspiration
– anechoic
– wall thickness normally <2-3 mm
– no wall layers
– diameter <4-5 cm
20
Gallebladder
21
Bile ducts Bile ducts
– ductus hepaticus communis/ choledochus <5-6 mm
– normally up to 8-9 mm after cholecystectomy?
– intrahepatic bile ducts follow v. porta
– dilated when: ”parallell sign”/ to many ductal structures
– colour-Doppler
– ”drei-spϋrige autobahn”
22
Bile ducts
23
Bile ducts – intrahepatic cholestasis
24
Intrahepatic cholestasis
25
Pancreas
» transversal-/ longitudinal access in the mid-line
» characteristic imaging picture with transversal access
» eventually by drinking 300-400 ml water
» great variation in size and form
» focal lesions?/ calcifications?/ cysts?
» ductus pancreaticus 1-2mm (dilated when >5mm)
26
Pancreas
27
Pancreas
28
Pancreatic duct Doppler
29
Cauda pancreatis – access from the spleen
30
Kidney
subcostal/ intercostal/ lumbal scan
longitudinal/ transversal scan
deep inspiration
parenchyma slightly hypoechoic compared to liver(1/3 x 2) » pyramids hypoechoic (cyst-like)
sinus is 1/3 (collecting system/ vessels/ fat/ connective tissue)
length 10-13 cm
31
Nyre
32
Kidney -hydronephrosis
33
Spleen
supine
intercostal, posterior access
echogenicity like liver
max size 12 x 8 x 4cm
accessory spleen in 2-3% of population
– 1-3 cm/ circular/ hilar location
34
Spleen Accessory spleen
35
Urinary tract/ genitals
ureteres normally not seen
urinary bladder – transversal/ longitudinel scan
– full bladder
– volume: h x b x l x 0,5
prostata – transducer behind symphysis
– full bladder
– volume: h x b x l x 0,5
36
Urinary bladder
37
Genitals
– uterus » longitudinal/transversal scan with full bladder in supine position
» hyperechogenic
– ascites in fossa Douglasi?
– ovaris » scan with full bladder on each side of uterus
» difficult because of intestinal loops
38
Uterus
39
Lymph nodes/adrenals/ascites/pleural fluid
lymph nodes – paraaortal in supine position
– most often hypoechoic
adrenals – difficult to visualise unless pathology
ascites: Morrisons pocket/ fossa Douglasi
pleural fluid
40
Stomach/ intestine – air/gas
– gastric imaging » after oral water intake
» normal wall thickness 2-5 mm
– intestine » small intestine: <2 mm (<4 cm)
» large bowel: <2-3 mm (<6 cm)
» ”target lesions”
» ”high frequency ultrasound”
wall layers
– hydrocolon sonography/ ”hydrosonography of the small bowel”
Target lesion cancer coli
41
42
Ileum terminale
Folvik et al. Scand J Gastroenterol. 1999 Dec;34(12):1247-52.
43
Large vessels
vena cava inferior – compressible/ Valsalva/ caliber variation
aorta – AAA (diameter>3 cm/ thrombus?)
coeliac trunk
superior mesenteric artery
44
Vena Cava Inferior
45
Aorta/ truncus coeliacus/ AMS
46
Truncus coeliacus
AAA with thrombosis
47