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AnnaTorres
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
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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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