Clinical Echography - Lectures
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77 Terms
what mode is used to measure size of cardiac chambers or resp variation of IVC
m-mode (motion)
linear transducer is used for
superficial structures
curvilinear transducer is used for
deeper structures
phased array transducer is used for
cardiac imaging
____ transducers are ideal for imaging sup. structures <6cm deep while _______ transducers are ideal for structures deeper than 5cm
linear
low-frequency
thermal index (ratio of emitted acoustic power : power needed to raise tissue temp by 1dg) must be kept to
TI <1.0
mechanical index (ratio of peak neg pressure) must be kept to
MI <0.7 or 0.4 for gas-filled structures
US exam of liver and biliary system: patient prep
fat free dinner the night before
fasting from midnight
reverberation artifact
false images from repetitive reflections bw highly reflective structures parallel to each other and US beam is perpendicular to these structures
A-lines
reverberation artefacts at pleural surface producing a series of horizontal lines
signifies absence of other patho signs
comet-tail artifact
presence bright hyperechoic focus at gallbladder lesion + inverted triangular acoustic enhancement post to hyperechoic focus
mirror-image artifact
from reflection of transducer waves and the target structure (ex diaphragm), creates structure identical (mirror image), deeper
edge shadowing artifact
refractive shadow at edges of curved structures (gallbladder, vessels) - dark shadow extending deep to edges of structure
acoustic shadowing
distal to highly attenuating structures, area of hypoechogenicity/shadowing created
acoustic enhancement
deep to fluid-filled structures, bright hyperechoic appearance of deep tissues
liver should be homogenous and slighty more echogenic than ______ and hypoechoic to ________-
right kidney
spleen
US right lobe of liver dimensions
ant post 12-13cm
craniocaudal axis 13-15.5cm
US caudate lobe of liver dimensions
antero-post <3cm
US left lobe of liver dimensions
antero-post <5cm
diffuse hepatic steatosis on US
increased echogenicity of liver (more than kidney)
blurry margins/poorly visualized hepatic and portal veins
focal hepatic steatosis on US
geographic hyperechoic area or multiple confluent hyperechoic lesions
cirrhosis (portal htn) on US
big caudate lobe, dilated portal vein >13mm
hemangioma on US
well-defined borders, hyperechoic
liver adenoma on US
heterogenous hypervasc mass, well-defined borders
hydatid cyston US
membrane ± daughter cysts = heterogenous mass
anechoic cyst w/ double echogenic lines separated by hypoechoic layer
honeycomb cyst, multiple septations
HCC on US
usually hypoechoic
± portal or hepatic v infiltrated, hypoechoic halo, mild post. acoustic enhancement, int. vascularity
liver metastasis on US
hypoechoic from hypovasc tumour
hyperechoic if hypervasc
bull’s-eye or target metastatic lesions (hypoechoic halo)
gallstones on US
mobile
acoustic shadow
wall-echo-shadow (WES) sign
gallbladder polyp on US
single/multiple round, non-mobile, no shadow
cholcystitis on US
Murphy’s sign, wall thickening >3mm
pericholcystic fluid
gallstones, sludge inside
intrahepatic biliary ductal dilatation is a sign of
distal bile duct obstruction
intrahepatic cholangiocarcinoma on US
duct filled w/ echogenic structures w/o acoustic shadowing
pancreas dimensions
A-P:
head 25-35mm
body 20-25mm
tail 25-30mm
acute pancreatitis on US
big pancreas, hypoechogenic
chronic pancreatitis on US
calcifications, pseudocysts
dilated and irregular pancreatic duct
irregular margins
dimensions of spleen
120/50mm
dimensions of kidney
100-120mm/50mm
hydronephrosis on US
calyceal ballooning, cortical thinning
what size kidney stone is unlikley to pass
>1cm
kidney cyst on US
thin/smooth walls, anechoic, post acoustic enhancement
prostate dimensions
40/40/40mm
normal aspect bladder
transverse plane, fluid filled bladder → post acoustic enhancement
bladder volume calculation
0.75 x W x L x H
bilateral jets in bladder rules out
obstructive uropathy
unilat jet in bladder raises suspicion of
obstruction on absent side
chronic cystitis on US
dilated wall
bladder stones on US
hyperechoic mobile masses w/ post acoustic shadowing
bladder mass on US
irregular echogenic projections from wall or focal wall thickening
thyroid dimensions
<2cm A-P (depth) and transverse (width)
4.5-5.5cm in length
normal thyroid on US
homogenous and hyperechoic (compared to strap muscles)
hashimoto’s thyroiditis on US
heterogenous, patchy hypo/hyperechoic areas
irregular margins, microcalcifications and tall shape of thyroid indicate
thyroid cancer
thyroid: benign colloid cysts display __________ and ________ artifacts
comet-tail artifacts
post acoustic enhancement
benign thyroid nodule on US
cystic nodule w/o solid component
what mode is used to assess lymph nodes
b mode
normal cervical lymph node on US
oval, homogenous, central hyperechogeniciity
<0.8cm
outer cortex - hypoechoic
abnormal lymph node on US
thin hypoechoic hilum
hypoechoic and heterogenous, round
sharp nodal borders, thick
increased periph vasc
if necrotic - heterogenous + no vasc
benign breast imaging
round, wide, smooth
up to 3 lobulations
encapsulated
enhancement shadowing
malignant breast imaging
taller than wide, irregular margins, multiple lobulations
echogenic halo
fixed
shadowing behind lesion
hypoechoic, calcifications
5 standard imaging views on cardiac exam
parasternal long axis
parasternal short axis
apical 4chamber
subcostal 4chamber
subcostal IVC
what can we see on parasternal long-axis view
RVOT, RV
what can we see on parasternal short-axis view
RV, LV size, septa
what can we see on apical 4 chamber view
RV and systolic fxn
what can we see on subcostal 4 chamber view
RV size, systolic fxn, wall thickness
low vs high CVP on IVC view
low - small IVC <2.1cm, >50% collapse
high - large IVC >2.1cm w/ <50% collapse
how to view mitral regurg
apical 4 chamber view
regurgitant jet, color jet fills >50% left atria in systole
how to view aortic regurg
parasternal long axis view - regurg flow into LVOT
rheumatic mitral stenosis on US
parasternal long axis view - diastolic doming, restricted opening of mitral valve, reduced mitral valve orifice
aortic stenosis on US
parasternal long-axis view - calcification, leaftlet thick, narrow valve
pericardial effusion on US
anechoic band around heart, separate pericardial layers bw liver and RV on subcostal 4chamber view
post accumulation fluid on parasternal long-axis view
lower extremity DVT on US
transducer transverse in popliteal fossa - a/hypoechoic, no compression, hyperechoic if chronic
patho lung is characterized by 3 abnormal findings
absence lung sliding (pneumothorax)
b lines (pul edema, pneumonia)
consolidation (pneumonia, atelectasis)
shred sign
consildation of lung that isn’t translobar
parapneumonic efffusion on US
plankton sign (floating debris, air bubbles), tiny echoes swirling, loculations
lung: well defined hypoechoic area in lobe suggests
necrosis or abscess
loss lung v., static air bronchograms are seen w/
atelectasis
findings suggestive of pneumonia
lung hepatization, dynamic air bronchograms (static in atelectasis),shred sign