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BASIC ABDOMINAL ECHO

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					                     The Renal Tract Ultrasound Technology
(1) Indication :
     甲、For image survey : search for visual lesion.
     乙、For intervention : biopsy guiding, drainage guiding.
(2) Technique:
     甲、A 3-7-MHz transducer is selected. Higher frequency for children and thinner patients.
     乙、Kidney approach
       i.   Subcostal space : low pole of kidney. Intercostal space : upper pole of kidney
      ii.   Sagittal section; coronal section; transverse section
       iii.    Right acoustic window : Liver ; Left acoustic window : Spleen
     丙、Other urinary tract approach
        i.    Pre- and post micturation
(3) Normal ultrasound appearance
     甲、Kidney
       i.  Size : 9-12 cm in length, 4-5 cm in width
      ii.  Cortex and medulla : 7.5-9.5 mm from capsule to pyramids tips, 15-16mm to sinus,
           hypoechoic appearance (compare to normal liver and spleen),
       iii.    Sinus : pelvicalyceal system, hyperechoic appearance
     乙、Urotract
     丙、Prostate
(4) Abnormal finding : \
     甲、Hydronephrosis, pyonephrosis, hemo-hydronephrosis
        i. Enlargement of the renal pelvis and calyces
       ii. Mild, moderate and severe
      iii. Dilatation or non-dilatation hydronephrosis
     乙、Urolithiasis
      i.    Size, location, acoustic shadow
     丙、Mass :
        i. Cyst, ADPKD or ARPKD,
       ii. Benign tumor : Angiomyolipoma, adenoma,
      iii. Maligency tumor : RCC, TCC, lymphoma, metastasis
     丁、Vessel :
      i.   Renal artery stenosis
     戊、Para-renal organ
      i.    Adrenal gland
     己、Congenital anomaly :
       i. Duplex kidney, horseshoe kidney, extra-renal pelvis,
                 BASIC ABDOMINAL ECHO

I.      Sonography
      Orientation:
            Transverse                                      Longitudinal




      Echogenicity:
      1. Anechoic (cyst)
      2. Hypoechoic (abscess)
      3. Isoechoic
      4. Hyperechoic (stones)


II.     What to see
          1. Liver
             --parenchyma, ligaments, diaphram, vasculature, biliary tract
             --Couinaud’s segments, divided to left and right lobes by Cantlie’s line




              --right lobe: anteromedial (S5, S8) and posterolateral (S6, S7)
              --left lobe: medial (S4) and lateral (S2, S3)
                --Normal size: 10 cm  2 over midclavicular line
                --Portal vein: thicker wall due to fibrofatty connective tissue, portal triad
                               runs transversely, 10mm-12mm, maximum 15mm
                               extrahepatic bifurcation, left (pars transversalis, pars
                               umbilicus) and right (anterior and posterior branch)
                --Hepatic vein: usually run vertically, wall not seen
                --CBD: 6-8mm in diameter, 7-11mm post cholecystectomy
            2. Gallbladder
               --anechoic, roughly oval shaped
               --normal wall thickness: ≦3mm
                --best viewed after NPO 6hrs
            3. Pancreas
               --head, body, tail (3cm, 2cm, 1cm respectively)
               --pancreatic duct not larger than 2mm
            4. Spleen
               --a X b  20cm2
               --length ( c )  12cm
            5. Kidneys


III.      Abnormal Findings
       Cirrhosis, hepatomegaly, fatty liver, tumors (HCC, hemangioma, metastatic
       lesions, FNH), abcess, cysts, calcifications, stones, biliary dilatations, ascites,
       fluid accumulation in Morrison pouch, venous congestion etc.


IV.      Sample of GI department abdominal sonography report
       Finding:


       *Liver: normal liver echotexture with smooth surface and sharp angle. Normal
              size and no space occupying lesion was depicted.
       *Portal Vein: unremarkable
       *Common bile duct: measured 0.6cm in diameter
       *Intrahepatic duct: no dilatation
       *Gallbladder: no wall thickening
       *Pancreas: blocked by intestinal gas
       *Spleen: no splenomegaly
       *Hepatic vein and inferior vena cava: unremarkable
       *Ascites/Others: nil
       **Diagnosis: Negative finding

				
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posted:4/2/2011
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