[SUBJECT]
ULTRASOUND You don't measure the left lobe unless abnormal
One of the most requested imaging modality
Different probes are used depending on what part of the RIGHT LOBE OF LIVER
body is studying: Probe should be position in the RUQ in the subcostal area
o Curve probe -for deep seated organs (just below the rib)
o Linear probe - for organs near the skin surface 2 views - parasagittal and transverse
o Endocavitary probe – used for transvaginal and Measured in 2 dimensions
transrectal imaging o span of the liver and;
o Cranial probe - for cranial ultrasound imaging o craniocaudal
15 cm - normal (upper limit)
Preparation before undergoing an ultrasound procedure:
o NPO at least 4 hrs prior to sched (esp in GALLBLADDER
gallbladder studies to keep the lumen open, since Position on RUQ near to the midline
gb contracts when with food) 2 views – parasagittal and transverse
o Give the patient water (at least 100ml) if urinary Normal limits:
bladder is included in the examination o Long axis is 6 cm (parasagittal view)
o Ultrasound gel is used to prevent any presence of o Normal limit in transverse view is 4 cm
air in b/w the skin and the probe o Gallbladder wall - 4mm
Correct way of positioning the probe: COMMON BILE DUCT
o Parasagittal – long axis CBD is formed by the hepatic and cystic duct
o Transverse – short axis 4 mm is normal measurement
o But can be up to 7 mm in elderly and post-
ORGANS being studied in abdominal UTZ: surgery (chole-) due to dilation
o Liver (Left and Right lobes)
o Gallbladder KIDNEYS
o Pancreas Probe is placed over the right and left flanks
o Spleen 2 views - parasagittal and transverse
o Common Bile Duct Normal measurements in adults
o Aorta o 9 to 12 cm normal (parasagittal)
o Urinary Bladder o 5 to 6 cm (transverse)
o Prostate (can be included but is usually a Cortex upper limit is up to 1.5 cm
separate study) Normally, the Left kidney is higher and is larger compared
to the right
When we request for abdomen ultrasound, we
indicate which part of the abdomen is being studied. - 1 cm - is the allowed difference between
Either UPPER (does not include the pelvis) or right and left kidney
LOWER (pelvic study). The physician may also opt
for WHOLE ABDOMEN - Pag matangkad ka, mahaba kidney mo
Only CT Scan, Ultrasound and MRI can do cross-sectional - Sa bata, kung ano age mo, yun ang size
studies ng kidney mo in approximation
PANCREAS SPLEEN
Put probe over the epigastric region, just below the Probe is placed over the Left flank just above the left
sternum kidney
Marker to locate the pancreas is the SPLENIC VEIN Window that is used to see the spleen is the LEFT
Looks like a sad emoji KIDNEY
You don’t measure the pancreas unless abnormal 12 cm - normal span
1 view only - transverse view 2 views - parasagittal and transverse
LEFT LOBE OF LIVER ABDOMINAL AORTA
Probe position same as pancreas Position of the probe is only parasagittal
Note that the end/tail of the left lobe should look like sharp Look for stenosis or plaques
end triangle (normal) One of the easiest to locate since it is big and pulsating
o If blunted or not sharp looking, most likely
enlarged and may indicate hepatomegaly URINARY BLADDER
2 views- parasagittal and transverse Lower abdomen/ pelvic area - puson
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DIAGNOSTIC IMAGING DATE
2 views - parasagittal and transverse
Fluid-filled prior to examination to see the bladder wall
when expanded/distended (100 ml)
o Prevoid - bladder is fluid filled, measured in
volume in 3 dimensions (2 transverse, 1
parasagittal)
o Postvoid - after urination, measured (3
dimensions as well)
Urinary retention
o Reason for checking prevoid and postvoid
measurement
o when fluid volume is >30% of the original volume
PROSTATE
If bladder is collapsed, prostate cannot be seen
Window/Landmark for prostate is URINARY BLADDER
Measured by volume in 3 dimensions
Normal volume of 30 CC
>30CC = BPH
CT SCAN OF ABDOMEN
Includes the base of the lungs down to the pelvis
Take note of this organs and how they look under the CT
SCAN:
o Pancreas- feathery in appearance
o Left lobe liver – sharp, triangular shape
o Large bowel – with gas with fecal materials
(mottled appearance)
o Small bowel – without gas
o Adrenal glands – looks like a letter Y or has limbs
Lifted from Learning Radiology, Chapter 14:
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DIAGNOSTIC IMAGING DATE
BODY CASES
CHOLELITHIASIS
Blurry region - is called fat stranding, it is a sign of
Case 5. 44y/o, F, right upper quadrant pain radiating to the
inflammation/infection
back
Most consistent findings are enlarged appendix and blurry
region
Most common cause is Fecalith and small particles
Appendix is attached in the cecum area
Hindi totoo yun naglaro kayo after kumain
magkakaappedicitis ka
LIVER CIRRHOSIS
Case 3. 60 y/o, M, Jaundice, pruritus, loss of appetite
UTZ is the initial modality for gallstones
Risk factors – Remember F5 (female, forty, fat, fertile, fair
– most common in Caucasians)
ACUTE APPENDICITIS
Case 8. Right lower quadrant pain, vomiting and fever
Presence of ascites, corrugated wall, smaller size
Heterogeneous appearance
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DIAGNOSTIC IMAGING DATE
FATTY LIVER DISEASE
Case 4. 41 y/o, Male, obese
(long white arrow) Transition zone – point of obstruction
BENIGN PROSTATE HYPERPLASIA
Case 10: 65 y/o M, frequent or urgent need to urinate and
dribbling at the end of urination
In UTZ- look for color of kidney, should be the same (if not
expect fatty liver)
CT- hypodense
UTZ- hyperechoic compared to kidney
HU of fat- should be negative (normal: 50-100)
SMALL BOWEL OBSTRUCTION (SBO)
Case 9. 34y/o, F, crampy abdominal pain and vomiting
There is encroachment at the base/floor of the urinary
bladder
Normal volume- 30 cc
Humps on base of urinary bladder - sign of an enlarged
prostate
Dilation, presence of intestinal lines (valvulae
conniventes), centrally located intestines
Post op adhesion – most common cause
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DIAGNOSTIC IMAGING DATE
COLON CANCER
Case 2. 65 y/o, M, blood in stools, significant weight loss
Increase size of paracholic gutter, centrally located
intestines, increase opacity
NEPHROLITHIASIS
Case 6: 33 y/o, male, left flank pain
Apple core deformity is caused by a colonic mass
ASCITES
Case 1. 48 y/o, M, Shortness of breath and increase in
abdominal girth
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DIAGNOSTIC IMAGING DATE
KUB xray - meaning kidney ureters, bladder, with or
without diaphragm
Abdominal xray - with diaphragm
If psoas muscle is blurred it may indicate presence of
abscess
Dilated renal calyces- due to obstruction distally (ureters)
Request CT- better imaging for detection of stone in ureter
Don’t use contrast in CT because the stone will not be
seen, and contrast fluid will not flow due to the obstruction
OTHER READING MATERIALS
Learning Radiology, Chapter 14: Recognizing the Normal
Abdomen and Pelvis on Computed Tomography
http://learningradiology.com/lectures/gilectures/plainabdo
men2012/Plain%20Films%20of%20the
%20Abdomen/Plain%20Films%20of%20the
URETEROLITHIASIS WITH HYDRONEPHROSIS %20Abdomen.html
http://www.dartmouth.edu/~anatomy/HAE/Abdomen/ab_in
Case 7. 47 y/o, M, right flank pain and hematuria dex.html
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