These sizes and other reference materials were gathered from a host of articles, books, lectures,

and occasionally the internet in the spring of 2007 by Travis Browning and Amy DeFatta.
Though they have been listed here in good faith, this list is neither complete nor infallible. Also,
remember that measurements are often just part of a diagnosis criterion. We hope this helps
with call and other occasions, but be aware that nothing is certain and all things are subject to
change. We also hope that others will continue to add to this file over the coming years so all
may benefit.

CARDIAC
Right atrial size right atrial bulge >5.5cm from midline on PA CXR
Left atrial size 40mm in diastole (on echocardiogram), on CXR <7cm from midinferior border
of left mainstem bronchus to the right lateral border of left atrial density, on lat CXR enlarged LA
displaces esophagus posteriorly and displaces left mainstem bronchus
Right ventricular myocardial thickness normal 3-4mm, on lat CXR enlarged RV fills retrosternal
clear space
Left ventricular myocardial thickness normal 9-12mm, on lat CXR enlarged LV displaces
posterior to IVC posterior border >1.8cm at a level cephalad to intersection of LV and IVC
Interatrial septum normally <10mm
Interventricular septum normally <13mm
Pericardial thickness 1-2mm, >4mm on lateral CXR suggests pericardial effusion
Pediatrics:


MAJOR VESSELS
Aortic root diameter normal 20 to 40mm, >4.5cm aneurysmal
Ascending aorta and aortic arch normal 3.0-3.5 cm
Abdominal aortic aneurysm >3cm diameter (1.5 times greater than normal vessel diameter), 5cm
is indication for repair
Iliac artery diameter normal 8-10mm, >3cm aneurysm is indication for repair
Pulmonary arteries normal diameters on CT (Requisites) Main pulmonary artery 28.6mm, left
main pulmonary artery 28mm, proximal right main pulmonary artery 24.3mm
Right interlobar artery on lat CXR 13mm in men, 12.5mm in women (intermediate bronchus as
medial border)
Pulmonary artery to bronchus size ratio normal 1.3-1.4:1 after takeoff of upper-lobe bronchi, in
periphery on CT ratio approaches 1:1
Main pulmonary artery diameter correlates to pulmonary artery pressure, >29mm is PAH
Normal pulmonary artery pressure P
sys
20mmHg, P
dias
10mmHg, P
mean
14mmHg, capillary
wedge pressure 5mmHg
Pulmonary artery hypertension P
sys
>30mmHg or P
mean
>25mmHg
Portal hypertension >5-10mmHg
Main portal vein on US normal <16mm diameter with deep inspiration, <13mm in relaxation
Normal IVC diameter 1.5 to 2.5cm
Mega cava diameter requiring birds nest IVC filter >28mm
SMA-Aorta angle >20 degrees, less than this is a set up for SMA syndrome
Ankle/Brachial Index (ABI) in peripheral arterial disease >0.9 nl, 0.5-0.9 mild-moderate disease,
<0.5 moderate-severe disease
Pediatrics:
Aortic root diameter normal 8 to 12mm

CAROTID ARTERY US
Normal Primary: ICA PSV <125 cm/sec; Plaque Estimate = None
Secondary: ICA/CCA PSV Ratio <2, ICA EDV <40 cm/sec
<50% Stenosis Primary: ICA PSV <125 cm/sec; Plaque Estimate = <50%
Secondary: ICA/CCA PSV Ratio <2, ICA EDV <40 cm/sec
50-69% Stenosis Primary: ICA PSV 125-230cm/sec; Plaque Estimate = 50%
Secondary: ICA/CCA PSV Ratio 2.0-4.0, ICA EDV 40-100 cm/sec
70% Stenosis Primary: ICA PSV >230cm/sec; Plaque Estimate = 50%
Secondary: ICA/CCA PSV Ratio >4, ICA EDV >100 cm/sec
Near Occlusion Primary: ICA PSV high, low, or undetectable; Plaque Estimate = visible
Secondary: ICA/CCA PSV Ratio variable, ICA EDV variable
Total Occlusion Primary: ICA PSV undetectable; Plaque Estimate = visible to no lumen seen
Secondary: Not applicable

AIRWAY/LUNG
Trachea and bronchus (Woodring et al, JTI 1991; 6:1-10)
o Male tracheomegally >25mm transverse and >27mm sagittal
o Female tracheomegally >21mm transverse and >23mm sagittal
o Male bronchomegally >21mm right mainstem bronchus, >18mm left
o Female bronchomegally >20mm right mainstem bronchus, >18mm left
Posterior tracheal stripe on lateral CXR 7mm, >7mm is soft sign for esophageal CA
Saber-sheath trachea reduced coronal diameter of trachea (<50% of sagittal diameter)
Emphysema diaphragm dome <2.7cm to line from ant-post diaphragm on lateral CXR, <1.5cm
on PA, retrosternal clear space 2.5cm on lateral CXR, right lung length on PA from 1
st
rib to
dome >29.9cm
Pulmonary edema pressure correlate vascular redistribution 10-17mmHg (Grade 1), interstitial
edema 18-25mmHg (Grade 2), alveolar edema >25mmHg (Grade 3) (though Ketai and Godwin
say This is an exercise in futility (JTI 1998; 13: 147-171)
V/Q scan PE grading (PIOPED)
o Normal no perfusion defects
o Very low probability Nonsegmental lesion, perfusion defect smaller than radiographic
lesion, 2 ventilation-perfusion matched defects with normal regional radiograph, 1-3
small segmental perfusion defects, pleural effusion of
1
/
3
or more of pleural cavity with
no other perfusion defect
o Low probability single large or moderate matched ventilation perfusion defect, >3
small segmental lesions, no perfusion to an entire lung, solitary lobar mismatch, moderate
pleural effusion (<1/3) with no other perfusion defect, heterogeneous perfusion
o Intermediate probability 1 moderate or <2 large segmental mismatched defects,
difficulty to categorize as high or low, solitary moderate or large segmental size triple
matched defect in lower lobe (zone)
o High probability 2 large mismatched segmental defects without a radiographic
abnormality or the equivalent in moderate defects (2 moderate = 1 large defect)
Pediatrics:


MEDIASTINUM
Widened mediastinum on CXR - >8cm transverse @ top of aortic arch
Other signs of mediastinal hematoma on CXR esophageal (NGT) deviation to right of T4
spinous process (non-rotated film), tracheal deviation to right, poor arch definition, obscured A-P
window, apical caps, widening of paraspinous or paratracheal stripes
Pediatrics:


LYMPH NODES
Upper size short axis for neck level LN 1cm
for epitrochlear LN 0.5cm
for jugular-digastric and submandibular LN 1.5cm
for hilar/mediastinal LN 1cm
for pericardial-phrenic LN 0.8cm
for internal mammary LN if see, then abnormal
for azygoesophageal access LN 1.5cm
for retrocrural LN 0.6cm
for porta hepatis LN 0.8cm
for portacaval space LN 1.2cm
for mesenteric LN 0.5cm
for retroperitoneal LN 1cm
for perirectal LN 0.3-0.5cm
for upper paraaortic region LN 0.9cm
for lower paraaortic region LN 1.1cm
for pelvic LN 1.0 cm
for inguinal LN 1.5cm
Pediatrics:


LIVER/SPLEEN
Hepatomegally >17cm in length (right lobe length), possibly less if left lobe prominent
Splenomegally >12cm in length
Splenic index normal 120 to 480 cm
3
(L*W*D)
Fatty liver changes ( normal liver 50-70HU) >10HU less than spleen noncontrast
o >25HU less than spleen during portal-venous phase of contrast (less specific and need
additional findings to suggest)
Fatty liver on MR >10% signal dropout on out-of-phase sequence
Liver transplant US evaluation hepatic artery acceleration time <80msec, RI 0.5-0.7 in normal
Pediatrics:


BILIARY SYSTEM/GALLBLADDER
Intrahepatic biliary ducts normal <40% of diameter of adjacent portal vein (by US) or <2mm
Common bile duct 67mm (mid)
o Equation by age upper normal is 6mm + 1mm/decade over 60 (variable)
o Healthy subjects <65 upper nl is 6-7mm
o Healthy subjects > 65 upper nl is 10mm
o Some dilatation following cholecystectomy is expected
Common hepatic duct 3-6mm
Gallbladder wall 3mm. If gallbladder contracted, can be 5mm.
Pediatrics:
Common bile duct 3mm

PANCREAS:
Pancreas size 3cm head, 2.5cm neck and body, tail 2cm
Pancreatic duct upper normal limit 3mm in young patient, >5mm in elderly
Pediatrics:
Pancreatic duct upper normal limit 3mm in young patient

ESOPHAGUS
Esophageal wall 3mm
Schatzkis ring usually symptomatic if narrows esophagus 12mm
Pediatrics:


STOMACH
Stomach wall 2-3mm adequately distended, any measurement >1.0cm abnormal
Gastric folds usually <5mm in distal stomach and <8mm proximally, >10 thickened
Pediatrics:
Hypertrophic pyloric stenosis single wall thickness >3mm, length >14mm (think , 3.14)

DUODENUM
Papilla along medial surface of 2
nd
duodenum, normal up to 1cm, >1.5cm enlarged
Giant ulcer benign ulcer 2cm diameter
Pediatrics:


SMALL BOWEL
Small bowel wall >3mm is considered abnormally thick
Small bowel diameter <3cm on KUB, <2.5cm on CT
Small bowel folds 2-3mm
In differential air/fluid levels of bowel 3cm or more of height difference favors obstruction over
ileus
Small bowel transit time 1-6 hours
Pediatrics:
Malrotation less than the normal 270 degrees of rotation of duojejunal loop around SMA

ILEOCECAL VALVE/APPENDIX
Ileocecal valve 3cm is upper normal, >4cm is enlarged
Appendix by ultrasound should be 6mm in diameter under compression
Appendix by CT 2mm wall thickness, if air or contrast filled then most likely normal (though
examine all the way to the tip), >12mm for fluid filled appendix is abnormal (>8mm if additional
signs can also suggest appendicitis)
Pediatrics:


COLON
Colon wall - >3mm is abnormal
Colon diameter <5cm (not cecum)
Colonic lymphoid follicles <5mm is normal size
Colonic psuedo-obstruction cecal diameter >10cm without evidence of mechanical obstruction
GI bleed 0.1mL/min to be visible on tRBC nucs scan, 1.0mL/min for angiogram
Pediatrics:
Risk of colon perforation in infectious colitis diameter >2.5 times width of L1 vertebral body
Air-enema for intusssception max pressure 120mmHg, hydrostatic method uses Rule of 3s
with 3 attempts, 3 minutes each, 3ft barium column above the table
Hirschsprungs disease Rectum/sigmoid ratio >0.9 (rectum is normally wider than sigmoid)


RECTUM
Presacral space measured at S4-S5, >1.5 or 2cm is too wide
Rectal valves of Houston normal width 5mm, width >7mm is usually abnormal, may be absent
in normal people
Anorectal angle normal 70 to 130 degrees, approaches 180 degrees with defecation, maintained
by puborectalis muscle
In defecography, movement of pelvic floor in excess of 3cm indicates abnormal descent
anorectal junction descending 3-4cm below ischial tuberosities is sign of weak perineum
Pediatrics:
Hirschsprungs disease Rectum/sigmoid ratio >0.9 (rectum is normally wider than sigmoid)

ADRENAL
Size 2-4cm length, 2-2.5cm width, 1cm thick (overall shape more important than any particular
measurement)
Adrenal adenoma measurements - <10HU on noncontrast CT, >50% washout of enhancement,
<35HU on delayed enhancement phase
Adrenal adenoma on MR 10-15% signal dropout on out-of-phase sequence
Pediatrics:


KIDNEY
Kidney normal 3-4 lumbar VB in length, 9-14cm long, 5-7cm wide
o Avg 9-12cm length, 8cm for short stature and 13cm for tall
Renal cortex 0.46-0.5cm, deceases with age
Right kidney is usually 1-2cm lower than left kidney
Kidney RI should be <0.7 by US (RI=P
sys
P
diast
/ P
sys
)
Renal Artery Stenosis best criteria is >200cm/sec PSV (compare to systemic velocity as well)
Pediatrics:


BLADDER/URETHRA/PROSTATE
Female urethra 2.5 to 4.0 cm long
Prostatic hypertrophy >30cc volume on US ((L*W*D)/2)
Ave prostate sono measurements 20-40mm CC, 21-34mm AP, 39-53mm TR
Ave nl prostate volume is 12.9cc to 37.1cc
Pediatrics:


TESTIS/EPYDIDYMIS
Normal adult size 5 x 3 x 3cm (normal volume 15-20cc by equation (L*W*D)/2)
Varicocele >2mm diameter veins
Epididymal head diameter 0.45-1.5cm any significant asymmetry is abnormal
Epididymal body/tail thickness <0.2cm-0.5cm any significant asymmetry is abnormal
Pediatrics:


UTERUS/OVARIES
Uterine length pre-pubertal 4-6cm, menstral 6-10cm, postmenopausal <9cm (5-6cm by 15-20
years postmenopausal)
Endometrial stripe thickness end of menses 1-4mm, proliferative phase 4-8mm, secretory 8-
16mm, postmenopausal without hormones 5mm (4-8mm by some), postmenopausal with
hormones is variable (15mm)
o Postmenopausal bleeding, 5mm excludes significant pathology, <8mm excludes
endometrial hyperplasia, 9mm Granberg recommends biopsy
o Sonohysterogram postmenopausal bleeding with endometrium >5mm, perimenopausal
bleeding with endometrium >10mm
Ovarian volume typically <10cc ((L*W*D)/2)
Increased risk of torsion with ovarian cyst diameter >5cm
Adenomyosis by MR junctional zone >12mm thick or >50% thickness of myometrium
Arcuate uterus cleft or impression on single endometrial cavity 1.5cm
Ovarian cystic mass vascular characteristics worrisome for malignancy internal flow, pulsatility
index (PI) <1.0, resistive index (RI) 0.4, absence of diastolic notch
Papillarities cystic ovarian mass wall thickening >3mm, concerning for malignancy
Ovarian veins in pelvic congestion syndrome tortuous and dilated with diameter >4mm and flow
<3cm/sec
Pediatrics:
Uterine length pre-pubertal 4-6cm
Endometrial stripe thickness premenstrual normally not seen, if present then very thin line

OB SONO
First trimester is 0-14wks, 2
nd
trimester is 14-28wks, third trimester is 28wks-term
Quad test performed between 16-18wks (upto 15-20wks): MS-AFP, B-hCG, estriol, inhibin
AFI >25cm is polyhydramnios, single deepest pocket (mild >8cm, mod >12cm, severe >16cm)
AFI <8cm is oligohydramnios or largest pocket <2cm, normal AFI ~15cm
Ventricular atrium >10mm is abnormal
Cerebellum estimates gestational age as measured in mm during 2
nd
trimester
Cisterna magna width <2mm or >12mm is abnormal
Nuchal lucency measured at 11-14 weeks gestation, >3mm abnormal
Nuchal fold outer skull to outer skin, >5mm is abnormal (measured 15-20 weeks gestation)
Spine seen in entirety through L5 by 16 weeks, S1-S5 then ossify sequentially every 2-3wks
Fetal renal pelvis hydronephrosis 4mm @16-20 weeks, 7mm after 34 weeks gestation
Fetal heart rate nl 120-160 bpm, bradycardia <100 bpm, SVT 180-300 bpm, atrial flutter 300-
400 bpm, atrial fibrillation >400 bpm
Twin discordance (largest weight-smallest weight)/(largest weight), >25% worrisome for twin-
twin transfusion
First trimester demise fetal pole 10mm (>25mm transabdominally) and no heart motion by m-
mode or color Doppler
Anembryonic pregnancy mean gestational sac diameter 20mm and no fetal pole seen
Intrauterine pregnancy mean gestational sac diameter <20mm and fetal pole <10mm is or is not
seen, also when embryonic pole and heart motion is detected
No IUP of 4-5 weeks use if NO gestational sac is seen

MSK
Ankle Lateral clear space 5mm, Medial clear space 3mm
Hardware loosening and/or infection >2mm lucency around hardware
o Normal loss of medial femoral cortex in hip arthroplasty <5mm
o In hip arthrogram contrast below intertrochanteric line for femur, contrast in zone II for
acetabulum (zone I supralateral, zone II mid superior, zone III inframedial)
Bone island 0.2-2.0cm, Giant bone island >2-3cm (usually in pelvis)
Cartilage cap on osteochondroma benign <1.5cm (0.1-3.0cm), malignant >1.5cm (1.5-12.0cm)
Normal knee valgus 7-10
o
valgus (distal end out)
Patellar tendon length 1-1.5x length of patella
Normal ACL angle on sagittal view - ~45 degrees to slightly more vertical
Lateral atlantoaxial offset (open mouth view) 2mm
Pre-odontoid space (lateral view) 3mm
Pretracheal space at C6 22mm
Facet width in C-spine 2mm
Listhesis with flexion/extension in C-spine 2mm
Retropharyngeal space at C2 7-8mm (unless tube in place or crying child)
Sagittal imaging of knee medial meniscus posterior horn 2-3 times larger than anterior horn
Sagittal imaging of knee lateral meniscus posterior horn = anterior horn
Lateral femoral condyle notch 2mm, >2mm is deep notch sign associated with ACL injury
Scaphoid-lunate joint <3mm
Plantar fascia thickness 4mm, >4mm indicates fasciitis
Boehlers angle angle between lines from anterosuperior angle of calcaneus to superior most
point of calcaneus and superior calcaneal tuberosity to most superior part of calcaneus, normal is
30-35 degrees, <30 suggests calcaneal fracture
Classification of Bone Marrow Density (DEXA scans)
o STANDARD mean BMD of 25 yo female
o NORMAL BMD from mean to 1 SD below mean (mean to -1 SD)
o OSTEOPENIA T-score 1 to 2.5 SD below mean (-1 to -2.5 SD)
o OSTEOPOROSIS T-score >2.5 below mean (>-2.5 SD)
Pediatrics:
Slipped capital femoral epiphysis - <
1
/
6
femoral epiphysis extending laterally to line along lateral
femoral neck cortex
Normal acetabular angle 15-30 degrees (horizontal Hilgenreiner line and vertical Perkins line),
angle decreases with age
Pre-odontoid space (lateral view) 5mm
Pretracheal space at C6 14mm

NEURO
Normal conus level T11-L2
Vestibular aqueduct (posterior to vestibule in inner ear) <1.2mm diameter, enlarged vestibular
aqueduct syndrome >1.5mm
Pineal gland calcification >1cm is abnormal
Pediatrics:
Thickened filum terminale >2mm at L5
Cerebellar tonsils 5mm below foramen magnum, >5mm is Chiari I
Pineal gland calcification before 6 years old is abnormal
Helpful Illustrations


1. Peroneus tertius M.
2. Calcaneal (Achilles) tendon
3. Inferior extensor retinaculum
4. Superior peroneal retinaculum
5. Tendons m. extensor digitorum longus
6. Inferior extensor retinaculum
7. Extensor digitorum brevis m.
8. Tendon m. peroneus tertius
9. Tendon m. peroneus longus
10. Tendon m. peroneus brevis
11. Tuberosity, fifth metatarsal bone


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