Ultrasound of Abdomen

- Liver and spleen

- Biliary system

- Vasculature

- GYN (uterus, ovaries, and cervix)

- Pediatrics

What organs can be examined using ultrasound?

ultrasound

imaging that uses high frequency sound waves directed by a narrow beam into the body. Piezoelectric crystals change electric energy into high frequency sound waves. Each tissue has different acoustic impedance determined by the density. The reflected sound (echo) returns to the transducer and is converted to electrical signal which is converted into an image.

echogenic, gray/white

on ultrasound, solid organs are ___________ meaning they appear ______ on image

anechoic, black

on ultrasound, fluid collections are _____ meaning they appear _____ on image

echogenic

Capable of producing echoes

air and bone

_____ cannot be adequately visualized on ultrasound. The acoustic impedance is too high. They are TOO echoic.

X-ray: Fluid is white

U/s: Fluid is black

What is the color of fluid on X-ray and ultrasound?

anechoic

fluid and blood are ___ on ultrasound

- Linear array

- Curved array

- Phase array

types of transducers used for Ultrasound

isoechoic

region of image that is equal to the surrounding (or another structure it is being compared to)

Linear array

transducer in which each sound pulse travels in the same direction and is perpendicular creating a rectangular image. Near field has high resolution. It is good for limited group of adjacent elements but limited deep field of view.

Linear

____ array transducer is food for superficial structures such as tendons, thyroid, and vessels.

high, poor

Linear array transducers have ____ frequency, but ____ penetration

Curved array

transducers with surface reformed into a convex shape. Has a wider far field with slightly reduced resolution. Large deep and small superficial field of view.

Curved

____ array transducer would be used to visualize deep organs such as Intraabdominal organs.

low, deep

Curved array transducers have ____ frequency and ____ penetration.

Phase array

transducers that are smaller and capable of scanning in areas where acoustic access is limited (between ribs). Small superficial field of view. Poor near field focusing. Limited periphery focusing capabilities. Good for doppler imaging.

Phase

____ array transducers are good for imaging hard to reach areas like the heart.

Hyperechoic

echo-rich structure when compared to adjacent structures; appears as varying shades of lighter gray. Aka echogenic.

isocheoic

having similar echogenicity to an adjacent structure

hypoechoic

less reflective and low amount of echoes when compared with adjacent structures; varying shapes of darker grey

anechoic

totally black on ultrasound, no echoies, aka sonolucent. Usually represents liquids such as blood or fluid collections.

sonolucent

another word for anechoic is ______

artifacts

a structure or appearance that is not natural, but is due to manipulation. Refer to something seen on the ultrasound image that does not exist in reality. Can be helpful in interpreting the image or it can confuse the examiner.

Anechoic

the central fluid accumulation could be described as _____.

Hypoechoic

the central lesion could be described as ______.

Isoechoic

the testicles are ____ to each other

hyperechoic

the bowel is ____ in comparison to the surrounding tissue

- shadowing

- posterior enhancement

Artifacts that may be seen on ultrasound....

shadowing

artifacts on ultrasound caused by stones, calcifications, and bone

posterior enhancement

artifacts on ultrasound caused by fluid and fluid containing structures.

Acoustic enhancemnet

a manifestation of increased echo amplitude returning form regions beyond an object such as a fluid filled cyst, which causes little or no attenuation of the ultrasound.

acoustic shadowing

______ on an ultrasound image is characterized by a signal void behind structures that strongly absorb or reflect ultrasonic waves. This happens most frequently with solid structures, as sound conducts most rapidly in areas where molecules are closely packed, such as in bone or stones.

acoustic enhancement

acoustic shadowing

Doppler

measures blood flow toward or away from the transducer. Can measure blood flow and velocity.

Red

on the doppler, ____ indicates flow towards the transducer

Blue

on the doppler, ____ indicates flow away from the transducer

high

____ frequency transducer is used to visualize superficial structures such as the thyroid, MSS, and scrotum.

low

____ frequency transducer is used to visualize deep structures such as the abdomen and pelvis.

brighter

strongly transmitted pulse causing strong returning echoes causes a _____ image

phased array

probe used when you need to image deep structures

linear probe (vascular probe)

probe used for superficial structures.

notch

___ is made to help determine your orientation on the screen to the probe

long view

view the the notch is pointing towards the patients head. Consequently, the left of the screen is superior and the right of the screen is inferior. The top of the screen is anterior and the bottom is posterior.

head

in the long view, the notch should be pointing toward the patients head

superior, inferior

in the long view, the left of the screen is ____ and the right of the screen is _____

anterior, posterior

in the long view, the top of the screen is ____ and the bottom of the screen is _____

trans view

view in which the probe is pointing towards the person scanning. In that case, the left of the image is the patients right.

you must also see it in the trans view

If you see a cyst in the long view, what is the next step?

4 x 10 cm

Fasting GB should measure...

less than or equal to 3 mm

Gallbladder wall should measure...

no more than 4 mm

common hepatic duct should measure

no more than 6 mm

common bile duct should measure

no more than 2mm

pancreatic duct should measure

normal GB

Normal GB (folds on itself)

Post prandial Gallbladder (Normal)

Cholelithiasis

Cholelithiasis

GB sludge

move patient to see sludge move

GB with sludge and stones

- wall thickening greater than 3mm

- pericholecystic fluid

- Murphy's sign

- with and without stones

What to look for in suspected acute cholecystitis...

Cholecystitis

GB wall thickened with edema, pericholecystic fluid

Cholecystitis

Chronic Cholecystitis

WES sign is indicative of _____.

WES sign...

Wall

Echo

Shadow

What do you look for in suspected chronic cholecystitis?

Chronic Cholecystitis

WES sign

normal CBD

liver

Because flow of blood into the ____ through the portal vin is strongly linked with the spleen, intestines, stomach, ascites, edema, etc. If the ___ is abnormal looking on US then expect problems with the rest of the organs and systems.

normal liver

Liver Cirrhosis

liver blackened out

Liver Mets

liver

Ascites

Normal kidney

Hydronephrosis

Hydronephrosis

nephrolithiasis

kidney

normal urinary bladder

suprapubic US

abnormal growths on bladder wall

suprapubic US

Bladder Jets

normal finding

Foley on bladder US

bladder

normal testes

testicle with good blood flow

right testicular torsion

torsion

Phased array probe

Which transducer would you use for performing an abdominal scan?

Acoustic enhancement

this image represents...

L is hypoechoic structure when compared to surrounding tissue

Describe the structure labeled L in comparison to the surrounding tissue?

head, scanner/operator

in the long view, the notch should be pointing to the ___ of the patient, where in the trans view, the notch should be pointing toward the ______.

False

T/F: Red color on doppler means that the vessel is an artery.

pleural effusion, ascites

fluid superior to the diaphragm is ____, where fluid inferior to the diaphragm is called _____