Comprehensive Ultrasound Image Identification and Cross-Sectional Anatomy Guide

Administrative Policies, Course Procedures, and Exam Guidelines

  • Curricular Adjustment on Video Quizzes:

    • The scheduled video quizzes covering arterial stenosis have been permanently removed from this course grade book.
    • Identical video instructional materials and associated worksheets have been transferred to the concurrent ultrasound lecture course to prevent redundant viewing.
    • Core conceptual topics introduced in those videos—specifically arterial hemodynamic changes occurring proximal to a stenosis, within the stenosis, and distal (posterior) to a stenosis—remain mandatory test material for this class and will be taught directly using whiteboard diagrams.

  • Post-Test Examination Review:

    • Date and Time: Scheduled for November 2 at 08:30 AM08:30\,\text{AM}.
    • Mandatory Threshold: Attendance and completion are required for any student scoring an 8383 or lower on the prior examination.
    • Format and Requirements:
    • The review runs for a total duration of 2.5 hours2.5\,\text{hours}.
    • The session operates as an independent lookup assignment rather than an instructor-led rationalization of missed items.
    • Each attendee receives a blank copy of the completed examination.
    • Students must independently look up every single question on the test, identify and circle the correct answer, write the exact textbook page number where the answer was verified, and submit the completed paper at the end of the session.
    • The comprehensive nature of this exercise reinforces core sonographic concepts in preparation for the cumulative final examination.

Image Identification Labeling Conventions and Protocol Rules

  • Strict Scoring and Partial Credit Policy:

    • No partial credit is awarded on image identification assignments or practical examinations.
    • Omission of scanning planes or positional descriptors results in a score of zero for that item (e.g., writing only "common bile duct" when the structure is a "sagittal common bile duct" receives no credit).
    • Every structure must be fully qualified with all applicable directional and anatomic descriptors: scan plane (sagittal or transverse), level (proximal, mid, or distal), and position (superior, inferior, lateral, or medial).

  • Vessel Geometry and Scan Plane Designations:

    • Any blood vessel presenting with a circular cross-section on the display must be designated as transverse.
    • Any blood vessel presenting with an elongated, tubular structure on the display must be designated as sagittal (or longitudinal), regardless of the transducer's orientation on the patient's skin surface.
    • Anatomic confluence regions and non-vascular spaces (e.g., portal splenic confluence, Morison's pouch) do not require planar prefixes because they represent junctions or potential spaces rather than tubular conduits.

Abdominal Aorta, Inferior Vena Cava, and Primary Branches

  • Transverse Proximal Aorta and the Celiac Axis ("Seagull Sign"):

    • Anatomic Relationship: Visualized immediately superior to the transverse midline pancreas.
    • 1. Transverse Proximal Aorta: The proximal segment of the abdominal aorta is defined anatomically as the portion located superior to the celiac axis origin.
    • Celiac Axis Branches: The celiac trunk gives rise to three branches, two of which are consistently visualized on diagnostic ultrasound:
    • 2. Sagittal Common Hepatic Artery (CHA): Courses toward the patient's right into the liver; appears tubular in this view and is therefore labeled sagittal.
    • 3. Sagittal Splenic Artery: Courses toward the patient's left toward the spleen; appears elongated and tubular on the screen and is labeled sagittal.
    • Left Gastric Artery: The third branch of the celiac trunk; courses toward the patient's left but is typically not visualized on ultrasound.
    • 4. Sagittal Celiac Axis (Celiac Trunk / Celiac Artery): First anterior visceral branch of the abdominal aorta; labeled sagittal when displayed as a longitudinal tubular segment.

  • Sagittal Aorta and Visceral Branches:

    • 5. Sagittal Proximal Aorta: The segment located superior to the take-off of the celiac axis.
    • 6. Sagittal Celiac Axis (CA / CT): Arises as the first anterior branch off the aorta.
    • 7. Sagittal Superior Mesenteric Artery (SMA): Second anterior visceral branch arising approximately 1 cm1\,\text{cm} inferior to the celiac axis; projects anteriorly before turning to run parallel to the longitudinal aorta.
    • 8. Sagittal Mid Aorta: The segment of the abdominal aorta located inferior to the origin of the SMA and superior to the origins of the renal arteries.
    • Diaphragmatic Crura: A hypoechoic linear muscular structure visualized coursing immediately anterior to the abdominal aorta.

  • Coronal Approach of the Great Vessels:

    • Right Coronal Approach:
    • Orientation: Transducer placed on the right lateral/coronal flank. Screen top corresponds to patient right; screen bottom corresponds to medial/left; screen left is superior; screen right is inferior.
    • 13. Sagittal (or Coronal) Right Lobe of the Liver: Acoustic window located at the top of the field.
    • 9. Distal Sagittal (or Coronal) Inferior Vena Cava (IVC): Directly abuts the visceral surface of the liver. Venous flow originates in the peripheral microcirculation (anatomically proximal) and drains into the right atrium of the heart (anatomically distal); thus, the IVC segment nearest the heart is designated as distal IVC.
    • 10. Distal Sagittal (or Coronal) Aorta: Located deep/medial relative to the IVC, defined as distal because it is inferior to the renal artery take-offs.
    • 11. Sagittal Right Renal Artery (RRA): Arises from the aorta and courses horizontally toward the IVC.
    • 12. Sagittal Left Renal Artery (LRA): Arises from the aorta and courses laterally toward the left kidney.
    • Left Coronal Approach:
    • Orientation: Transducer placed on the left lateral flank to visualize the distal aortic bifurcation.
    • 14. Sagittal (or Coronal) Distal Aorta: Anteriorly positioned great vessel terminating at the aortic bifurcation.
    • 15. Sagittal Left Common Iliac Artery (LCIA): The anterior vessel extending from the bifurcation. Must be designated as "common" iliac; omit "common" and the answer is graded incorrect.
    • 16. Sagittal Right Common Iliac Artery (RCIA): The corresponding branch extending into the right pelvic cavity.

  • Transverse Midline Vasculature and Relationships:

    • 17. Transverse Mid Aorta: Circular vascular cross-section situated anterior to the acoustic shadowing of the vertebral spine.
    • 18. Transverse Mid IVC: Oval, collapsible vessel located to the patient's right of the aorta, directly contacting the liver.
    • 19. Sagittal Left Renal Vein (LRV): Elongated tubular structure emerging from the left renal hilum, coursing between the posterior wall of the SMA and the anterior wall of the aorta, to empty into the IVC. The LRV is the only vessel that appears between the aorta and the SMA in normal anatomy (100%100\% of standard presentations).
    • 20. Transverse Superior Mesenteric Artery (SMA): Circular cross-section with an echogenic collagenous wall, positioned anterior to the LRV.
    • 21. Portal Splenic Confluence (PSC): Junction where the splenic vein and superior mesenteric vein combine to form the main portal vein.
    • 22. Sagittal Splenic Vein: Tubular vessel traveling horizontally along the posterior border of the pancreatic body and tail.

  • Sagittal Inferior Vena Cava:

    • 23. Sagittal Distal IVC: Superior-most longitudinal segment entering the right atrium.
    • 24. Transverse Right Renal Artery (RRA): Small circular cross-section visualized directly posterior to the longitudinal IVC. This is the only vessel that courses posterior to the longitudinal IVC.
    • 25. Sagittal Distal IVC: Upper hepatic segment adjacent to the caudate lobe of the liver.
    • 26. Sagittal Mid IVC (or Proximal IVC): Segment inferior to the intrahepatic course.
    • Posterior Hammocking: Distinctive anatomic contour where the IVC dips posteriorly beneath the left lobe/caudate lobe of the liver before ascending toward the right atrium.

  • Transverse Distal Great Vessels (Umbilical Level):

    • Transducer Position: Placed in the lower abdomen near the level of the umbilicus.
    • 28. Transverse Proximal IVC: Located on the patient's right, anterior to the spine. (Venous origin in pelvis/lower extremity makes the inferior-most IVC anatomically proximal).
    • 29. Transverse Right Common Iliac Artery (RCIA): Right-sided arterial branch from the aortic bifurcation.
    • 30. Transverse Left Common Iliac Artery (LCIA): Left-sided arterial branch from the aortic bifurcation.

Liver Parenchyma and Hepatic / Portal Venous Systems

  • Acoustic and Morphologic Differentiation:

    • Portal Veins: Feature highly reflective, hyperechoic (bright) fibrous/collagenous walls. Course intrasegmentally (horizontally/transversely within the hepatic lobes).
    • Hepatic Veins: Possess imperceptible, thin, non-echogenic walls lacking hyperechoic collars. Course intersegmentally and interlobar (longitudinally/vertically) to drain superiorly into the IVC.

  • Hepatic Veins and the "Playboy Bunny" / "Deer Sign":

    • Visualized in a transverse sweep through the superior right and left lobes of the liver adjacent to the diaphragm.
    • 3. Sagittal Middle Hepatic Vein (MHV): Courses between the right and left hepatic lobes along the main lobar fissure.
    • 5. Transverse Inferior Vena Cava: Confluence point for hepatic venous drainage.
    • 6. Sagittal Right Hepatic Vein (RHV): Divides the anterior and posterior segments of the right hepatic lobe.
    • 7. Sagittal Middle Hepatic Vein (MHV): Central trunk dividing the right anterior segment from the left medial segment.
    • 8. Sagittal Left Hepatic Vein (LHV): Divides the left lobe into lateral and medial segments.

  • Portal Venous Branching Architecture:

    • Left Portal Vein (LPV) Course: Any portal vessel positioned on the patient's left side of the middle hepatic vein represents the left portal venous system.
    • 9. Sagittal Ascending Left Portal Vein: Courses anterior-to-posterior within the left hepatic lobe.
    • 10. Sagittal Lateral Branch of the Left Portal Vein: Supplies the lateral segments of the left lobe.
    • 11. Sagittal Medial Branch of the Left Portal Vein: Supplies the medial segments of the left lobe, positioned closer to the middle hepatic vein.
    • Right Portal Vein (RPV) Course: Once the extrahepatic main portal vein enters the liver parenchyma (surrounded anteriorly and posteriorly by liver tissue), it becomes the right portal vein.
    • 4. Transverse Posterior Branch of the Right Portal Vein (RPV POST): Supplies the posterior segment of the right lobe.
    • 14. Sagittal Anterior Branch of the Right Portal Vein (RPV ANT): Courses toward the anterior segment of the right lobe.
    • 15. Sagittal Posterior Branch of the Right Portal Vein (RPV POST): Courses toward the posterior segment of the right lobe.
    • 16. Transverse Right Lobe of the Liver: General hepatic parenchyma surrounding the bifurcation of the right portal vein.

  • Hepatorenal Space and Longitudinal Reference Structures:

    • 17. Sagittal Right Lobe of the Liver: Liver parenchyma abutting the superior pole of the kidney.
    • 18. Sagittal Right Renal Sinus: Central hyperechoic core of the right kidney.
    • 19. Morison's Pouch: The potential intraperitoneal space between the visceral surface of the right hepatic lobe and the anterior capsule of the right kidney. (Does not require a planar prefix).
    • Reference Point Rule: When the kidney is depicted in the sagittal plane, the adjacent liver tissue must be labeled as sagittal right lobe. When the kidney is depicted in the transverse plane, the adjacent liver tissue must be labeled as transverse right lobe.

  • Longitudinal Midline Liver Relationships:

    • Sagittal Left Lobe of the Liver: Liver tissue located anterior to the IVC, distal aorta, and caudate lobe.
    • Transverse Main Portal Vein: Identified within the left/central porta hepatis by its round cross-section with hyperechoic margins.

Gallbladder, Biliary Tree, and Porta Hepatis Relationships

  • Anatomic Divisions of the Gallbladder:

    • 1. Sagittal Gallbladder Neck: The most superior and posterior portion of the organ, continuous with the cystic duct.
    • 2. Sagittal Gallbladder Body: The middle, main reservoir portion.
    • 3. / 5. Sagittal Gallbladder Fundus: The most anterior, inferior, and lateral portion; extends beyond the inferior margin of the right hepatic lobe to contact the anterior abdominal wall.

  • Gallbladder Wall Thickness:

    • 16. Longitudinal Gallbladder Wall Measurement: Measured on the anterior wall in a longitudinal scan plane.
    • Normal Dimension: Less than 3 mm3\,\text{mm} (<3 mm< 3\,\text{mm}); measurements of 3 mm3\,\text{mm} or greater are pathologic (cholecystitis, diffuse edema).

  • Anatomic Landmarks for Gallbladder Localization:

    • 18. Main Lobar Fissure (MLF): A hyperechoic linear band extending from the right/main portal vein to the neck of the gallbladder, serving as the landmark dividing the right and left hepatic lobes.
    • 19. / 20. Sagittal and Transverse Gallbladder Neck: Positioned immediately adjacent to the terminus of the main lobar fissure.
    • Sequential Landmarks in the Transverse Right Lobe Sweep:
    • Hepatic Dome →\rightarrow Hepatic Veins →\rightarrow Portal Veins →\rightarrow Gallbladder →\rightarrow Right Kidney.
    • The portal vein and the right kidney cannot be displayed concurrently with the gallbladder in the same transverse focal plane.

  • The Porta Hepatis Triad ("Mickey Mouse Sign"):

    • Anatomic Arrangement:
    • 6. Longitudinal Main Portal Vein (MPV): Large posterior tubular vessel entering the hepatic hilum.
    • Transverse Proper Hepatic Artery (PHA): Positioned anterior and medial (patient left) to the main portal vein.
    • Sagittal Biliary Conduit: Positioned anterior and lateral (patient right) to the main portal vein.
    • Differentiating Common Hepatic Duct (CHD) from Common Bile Duct (CBD):
    • 7. Sagittal Common Hepatic Duct (CHD): Segment of the extrahepatic biliary system located proximal (superior/lateral) to the level where the proper hepatic artery crosses.
    • 8. Sagittal Common Bile Duct (CBD): Segment of the biliary system located distal (inferior/medial) to the proper hepatic artery crossing, continuing toward the pancreatic head.
    • Vascular Variant of the Porta Hepatis:
    • In standard anatomy, the proper hepatic artery crosses anterior to the common duct.
    • In documented anatomic variants, the proper hepatic artery courses posterior to the common duct before entering the liver hilum (illustrated by items 13, 14, and 15).

Pancreas Anatomy, Vascular Relations, and Scanning Planes

  • Sonographic Scanning Plane vs. Organ Lie:

    • The pancreas lies horizontally across the retroperitoneum.
    • When the transducer is oriented in a transverse abdominal plane, the pancreas is sliced along its long axis, depicting the head, uncinate process, neck, body, and tail in a single elongated image.
    • By convention, sonographers label these elongated views according to the transducer orientation: transverse pancreas head, transverse pancreas neck, etc.
    • When the transducer is turned to sagittal, the beam cuts cross-sectional slices through the pancreas (like slicing a loaf of bread). These cross-sections must be labeled as sagittal pancreas head, sagittal pancreas body, etc.

  • Transverse Pancreas Anatomy and Landmarks:

    • 1. Transverse Pancreatic Head: Rests in the C-loop of the duodenum.
    • 2. Transverse Uncinate Process (UP): Posteromedial extension of the pancreatic head wraps posterior to the superior mesenteric vein (SMV).
    • 3. Transverse Pancreatic Neck: Constricted segment directly anterior to the SMV or portal splenic confluence.
    • 4. Transverse Pancreatic Body: Extends laterally toward the left, anterior to the aorta, SMA, and splenic vein.
    • 5. Transverse Pancreatic Tail: Extends into the splenic hilum, anterior to the upper pole of the left kidney.
    • Vascular Signposts in the Pancreatic Head:
    • Gastroduodenal Artery (GDA): Small circular cross-section positioned in the anterior-lateral margin of the pancreatic head.
    • Common Bile Duct (CBD): Circular cross-section positioned in the posterior-lateral margin of the pancreatic head.
    • Posterior Vascular Boundaries:
    • 6. Transverse Mid IVC: Directly posterior to the pancreatic head.
    • 7. Transverse Mid Aorta: Directly posterior to the pancreatic body.
    • 10. Transverse SMA: Directly posterior to the third portion of the duodenum and pancreatic body, wrapped by the uncinate process.
    • 8. Portal Splenic Confluence (PSC) and 9. Sagittal Splenic Vein: Direct posterior boundary of the pancreas body and neck.

  • Sagittal Pancreatic Cross-Sections:

    • Pancreatic Head Profile: Visualized anterior to the longitudinal IVC and inferior to the transverse main portal vein.
    • Pancreatic Neck and Uncinate Profile:
    • 26. Sagittal Pancreatic Neck: Anterior glandular structure.
    • Superior Mesenteric Vein (SMV): Interposed vascular landmark.
    • 27. Sagittal Uncinate Process: Posterior glandular tongue located directly posterior to the SMV.
    • Pancreatic Body Profile:
    • Visualized in sagittal midline anterior to the aorta, celiac trunk, and SMA.
    • Splenic Vein Cross-Section (20a): Lies directly along the posterior surface of the pancreatic body, resembling a "pig snout" appearance alongside the splenic artery.
    • Pancreatic Tail Profile:
    • Visualized in the left upper quadrant.
    • Splenic Artery and Splenic Vein: The splenic artery and vein run adjacent ("arm-in-arm") along the posterior surface of the pancreatic tail, diving posteriorly into the splenic hilum.

  • Fluid Evaluation in Pancreatitis:

    • Any anechoic fluid collections identified adjacent to the pancreatic bed represent peripancreatic free fluid or enzymatic leakage.
    • Protocol mandates documenting fluid in both sagittal and transverse planes, applying color Doppler to exclude vascular pseudoaneurysms, and measuring collection dimensions.

Renal Anatomy, Structural Landmarks, and Anatomic Variants

  • Renal Structural Zonation:

    • 1. Sagittal Right Kidney Cortex: Peripheral functional parenchymal rim; hypoechoic relative to normal liver tissue.
    • 2. Sagittal Right Kidney Sinus: Highly echogenic central compartment containing calyces, pelvis, fat, and neurovascular structures.
    • 4. Renal Pyramids: Triangular hypoechoic structures located within the medullary region between cortex and sinus.

  • Duplicated Collecting System Variant:

    • 3. Sagittal Right Kidney Mid: Identified by a continuous bridge of renal cortex completely traversing the central sinus, dividing it into discrete superior and inferior sinus poles.

  • Transverse Renal Pole Identification:

    • Polar Depth and Hepatic Coverage:
    • Superior Pole: Positioned deep/posterior within the retroperitoneum, completely covered anteriorly by a large volume of hepatic parenchyma; visualizes concurrently with the gallbladder neck.
    • Mid Kidney (Hilum): Demonstrates intermediate hepatic coverage; visualizes concurrently with the gallbladder body.
    • Inferior Pole: Extends anteriorly and inferiorly, demonstrating minimal or absent overlying liver tissue; visualizes concurrently with the gallbladder fundus.

  • Renal Hilar Architecture (Anterior to Posterior Rule: V-A-U):

    • In the transverse renal hilum, structures are aligned strictly from anterior to posterior:
    1. Renal Vein (V): Most anterior structure.
    2. 11. Sagittal Right Renal Artery (A): Middle structure; courses horizontally into the hilum.
    3. Right Ureter (U): Most posterior structure; typically collapsed and not visualized on ultrasound unless dilated by obstruction or vesicoureteral reflux.

  • Left Kidney Morphology and Anatomic Variants:

    • Dromedary Hump: A normal focal bulge or thickening of the lateral renal cortex, occurring predominantly on the left kidney due to localized remodeling from the adjacent spleen.
    • Organ Shape Differences: The right kidney exhibits an elongated configuration due to downward compression from the heavy liver; the left kidney is shorter, broader, and more pyramidal or "fluffy" in appearance.

Splenic Sonography and Left Upper Quadrant Relationships

  • Splenic Morphology and Orientation:
    • 1. Sagittal Spleen: Normal crescentic, homogeneous organ in the left upper quadrant.
    • 2. Diaphragm: Smooth, highly reflective hyperechoic curved line along the superior-posterior border of the spleen.
    • 3. Transverse Superior Spleen: Circular crescent lacking any renal parenchyma at its lower margin.
    • Pole Identification Rule: As the transducer sweeps inferiorly through the spleen in a transverse plane, the superior pole of the left kidney appears; absence of renal tissue confirms an image at the superior splenic pole.
    • 5. Sagittal Mid (or Medial) Spleen: Demonstrates the splenic hilum, the point where the splenic artery enters and the splenic vein exits.

Thyroid Gland, Cervical Vasculature, and Muscular Architecture

  • Transverse Thyroid Architecture:

    • 5. Transverse Right Lobe: Located lateral to the trachea on the patient's right.
    • 6. Transverse Left Lobe: Located lateral to the trachea on the patient's left.
    • 7. Transverse Isthmus: Thin central parenchymal bridge connecting the right and left lobes anterior to the trachea.
    • 8. Transverse Trachea: Midline curvilinear ring displaying dense anterior acoustic shadowing and reverberation artifact.

  • Cervical Vasculature:

    • Common Carotid Artery (CCA): Medially positioned, completely round, non-collapsible, thick-walled arterial lumen maintaining a patent caliber throughout the cardiac cycle.
    • Internal Jugular Vein (IJV): Laterally positioned, irregular, thin-walled, highly collapsible venous structure that changes diameter during respiration or transducer compression.

  • Muscular Landmarks of the Neck:

    • All neck muscles present as structures hyperechoic to thyroid parenchyma containing parallel echogenic striations.
    • 4. Sternocleidomastoid Muscle (SCM): Large, broad, superficial oval muscular band positioned anterior-lateral to the carotid sheath and thyroid lobe.
    • Strap Muscles: Group of small muscles situated immediately anterior to the thyroid lobes:
    • Any strap muscle touching the capsule of the thyroid has thyroid in its name (specifically the sternothyroid or thyrohyoid).
    • The omohyoid and sternohyoid muscles lie more anterior and superficial.

  • Sagittal Thyroid Imaging:

    • Display orientation represents anterior at the top, posterior at the bottom, superior at screen left, and inferior at screen right.
    • 11. Sagittal Thyroid Superior Pole.
    • 12. Sagittal Thyroid Mid Lobe.
    • 13. Sagittal Thyroid Inferior Pole.

Scrotal Anatomy, Testicular Vasculature, and Fluid Spaces

  • Scrotal Parenchymal Structures:

    • 1. Transverse Right Mid Testicle: Homogeneous medium-level granular echotexture.
    • 2. Transverse Left Mid Testicle: Symmetrical counter-structure.
    • 3. Scrotal Skin / Wall: Thin, hyperechoic peripheral encasement.
    • 4. Rete Testis: Network of delicate tubules situated within the mediastinum testis; normal variant presentations include benign cystic ectasia (dilated rete testis, Item 13).
    • 14. Mediastinum Testis: Linear hyperechoic band traversing the long axis of the testicle from superior to inferior, continuous with the rete testis.
    • Testicular Cysts: Benign, simple anechoic round fluid lesions possessing posterior acoustic enhancement.

  • Epididymis Architecture:

    • Positioned posterolateral to each testicle.
    • Head (Globus Major): Superior pole, triangular to rounded, equal or slightly hyperechoic to the testis.
    • Body: Slender segment coursing along the mid posterior aspect of the testis.
    • Tail (Globus Minor): Loosely attached segment positioned at the inferior testicular pole.

  • Testicular Blood Flow Mechanics:

    • 12. Sagittal (or Longitudinal) Capsular Artery: Courses circumferentially around the periphery beneath the tunica albuginea.
    • Centripetal Arteries: Branch inward from the capsular artery, coursing perpendicularly toward the mediastinum testis before looping back to supply the lobules.
    • 11. Testicular Vein: Drains peripheral parenchymal blood into the pampiniform plexus.

  • Peritoneal Analogy and Fluid Dynamics:

    • Physiologic Free Fluid (9): Small trace collections of anechoic fluid surrounding the epididymal head or tunica vaginalis layers are normal.
    • Etiology: The scrotum is lined by the tunica vaginalis, an embryologic continuation of the abdominal peritoneum composed of adjacent parietal and visceral mesothelial layers.
    • Function: These mucous membranes secrete lubricating serous fluid to eliminate frictional resistance during movement, identical to the function of abdominal peritoneal layers.

Questions and In-Class Discussion

  • Q&A: Labeling Conventions for Confluence Regions:

    • Question: Does the portal splenic confluence require a sagittal or transverse prefix when labeling?
    • Answer: No prefix is required. The confluence is an anatomic junction of multiple vessels (a noun/structure) rather than a continuous tubular conduit; it is only visualized in this form on transverse images and does not possess a longitudinal equivalent.

  • Q&A: Branches of the Left Portal Vein:

    • Question: Could you reiterate the identification of numbers 10 and 11 on the left portal vein image?
    • Answer: Structure 10 is the sagittal lateral branch of the left portal vein; structure 11 is the sagittal medial branch of the left portal vein. The medial branch is consistently positioned closer to the middle hepatic vein.

  • Q&A: Planar Labeling of Vessels within the Pancreatic Head:

    • Question: Should the gastroduodenal artery (GDA) and common bile duct (CBD) in the head of the pancreas also be labeled as transverse?
    • Answer: Yes. Because both vessels present as circular cross-sections in this view, they must be designated as transverse GDA and transverse CBD.

  • Q&A: Anatomic Order of Structures at the Renal Hilum:

    • Question: Where exactly is the vein located on the transverse renal hilum image?
    • Answer: The vein is the most anterior structure (depicted in blue Doppler flow), followed posteriorly by the renal artery, and finally the ureter in the most posterior position (V-A-U).

  • Q&A: Labeling Cervical Muscles:

    • Question: Should muscles visualized on transverse cervical scans be labeled with a plane?
    • Answer: Yes, simply label them as transverse (e.g., transverse sternocleidomastoid muscle).

  • Q&A: Labeling Peritoneal and Scrotal Free Fluid:

    • Question: In the scrotum, do we need to specify transverse when labeling free fluid?
    • Answer: No, free fluid does not have an intrinsic scan plane or tubular shape; writing free fluid without a planar prefix is correct.

  • Q&A: Vessel Orientation of the Capsular Artery:

    • Question: In the transverse scrotal view, should the capsular artery be labeled transverse or sagittal?
    • Answer: Because the vessel itself courses as an elongated tubular conduit along the margin of the testicle, it should be labeled sagittal (or longitudinal) capsular artery.