The Systematic Ultrasound Examination

13 The Systematic Ultrasound Examination

Now that you have learned the sonographic anatomy and interrelationships of the relevant organs, here are some guidelines on how to conduct a systematic ultrasound examination of the abdomen. Of course, the sequence in which the parts of the examination are performed will vary from one examiner to the next. The main thing for the beginner is to adopt a systematic routine that can be carried out within a certain period of time. In this system the abdomen is divided into seven topographic units:

1 Liver

2 Gallbladder and porta hepatis

3 Right kidney

4 Left kidney and spleen

5 Epigastrium and pancreas

6 Midabdomen

7 Lower abdomen

These units are shown schematically in Fig. 13.1 and are covered individually below.

images

Fig. 13.1 Topographic units of the ultrasound examination.

Topographic Units

LIVER

Shape

– Angle of inferior border

– Surface

Size

Structure

– Hyperechoic

– Pattern: coarse/fine

– Distribution

– Masses?

Vessels

– Hepatic veins
Diameter
Course

– Portal vein
Diameter
Course

Biliary tract

GALLBLADDER

Location

Size

Shape

Contents

Wall

Tenderness

Contracted?

Liver

Examination of the liver proceeds in three steps:

Survey in longitudinal scans.

Survey in transverse/oblique scans.

Survey in intercostal scans.

Reporting guidelines

The liver is:

normal in size and shape;

enlarged, diameter… cm on the mid clavicular line (MCL);

reduced in size.

The echo pattern:

is normal,

is homogeneous,

shows slightly/moderately/markedly increased echogenicity.

The angle of the inferior border is:

sharp,

slightly rounded,

blunted.

The hepatic veins are:

normal in appearance,

rarefied,

distorted.

No masses are seen.

Gallbladder and porta hepatis

Examination of the gallbladder proceeds in three steps:

1 Survey in longitudinal scans.

2 Survey in transverse/oblique scans.

3 Lateral intercostal scans.

Examination of the porta hepatis proceeds in two steps:

1 Upper abdominal oblique scan (“portal scan”).

2 Subcostal oblique scan.

Reporting guidelines

The gallbladder:

appears normal in size and shape,

shows postprandial contraction.

KIDNEYS

Location

Shape

Size

Mobility

Parenchymal pelvic ratio

Parenchymal pattern

Renal pelvis

– Contents

– Origin of ureter

Demonstrable adrenal gland?

SPLEEN

Size

Shape

Hilum

Accessory

Spleen

Varices

A lumen is not seen.

The gallbladder is free of stones.

Several stones with acoustic shadows are noted: size … cm.

The gallbladder is folded over at the fundus (“Phrygian cap”).

The gallbladder wall is thickened.

The gallbladder is tender to local pressure.

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Dec 26, 2015 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on The Systematic Ultrasound Examination
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