ULTRASOUND Abdomen

Adrenal
 4-6mm
 Thickness 2-4mm
 Width 2-3mm
Aorta
 The maximum AP outer wall diameter is the preferred measurement for assessment of aortic size
 Avoid transverse measurements if there is side to side tortuosity
 Total length of aneurysm measurements are of no use clinically and should not be quoted as this
can lead to confusion with the AP diameter
 Aneurysm > 3.0cm
Appendix
 Abnormal: Outer diameter ≥ 6mm, non compressible
Gall Bladder
 Width abnormal if > 4 cm
 Wall Thickness: abnormal > 3 mm
Bile Duct
 Normal ≤ 6mm
 Useful rule of thumb: bile duct caliber increases 1mm with each decade, i.e. 6mm at 60yrs, 7mm
at 70 yrs etc.
 Post cholecystectomy: 6-10mm indeterminate
Kidney Length
 Normal Range: lower 9-10cm, upper 12-13 cm, variable depending on body size
 Left usually longer than right, difference <1.5cm
Liver
 Mid hepatic line> 15.5cm enlarged in 75%
 Portal Vein < 1.3 cm, > 20% change in caliber with respiration
 Splenic Vein /SMV > 20% change in caliber with respiration
Pancreas AP Diameter
 Head 1.9 - 2.5 cm
 Body1.5 – 2.1 cm
 Tail 1.0- 2.0
Spleen
 Normal Length < 13 cm
 Rule of thumb for children: spleen length = 6 cm + 1/3 cm per year of age
Prostate
 Upper limit of normal: 30 cc

***

A list of normal radiological reference values is as follows:

1. adrenal gland: < 1 cm thick, 4-6 cm length

2. aorta: < 3 cm diameter

1
3. appendix: on CT < 6 mm calibre
4. atlantodental distance:
o adults - < 3 mm
o children - < 5 mm
5. azygous vein: on erect chest x-ray < 10 mm diameter
6. bladder wall: < 3 mm (well distended state)
7. boehler's angle: 20-40o
8. capitolunate angle: < 30o
9. carinal angle: < 60-70o
10. colon:
o lumen: < 5 cm
o wall: < 3 mm
11. common bile duct:
o < 7 mm and add 1mm for each decade over age of 60
o up to 10mm post cholecystectomy
12. diaphragm (right dome is usually higher than left)
o difference between right and left: < 3 cm
13. endometrial thickness:
o pre-menopausal: 3-15 mm
o post-menopausal: < 6 mm
14. esophagus wall: < 3 mm (with distended lumen)
15. gallbladder wall: < 3 mm (well distended)
16. heart (cardiothoracic ratio): < 55%
17. inferior vena cava: < 28 mm
18. internal carotid artery:
o PSV: < 125 cm/s
o EDV: < 40 cm/s
19. kidneys : 8-10 cm x 4-6 cm
20. liver span: < 15 cm
21. lymph nodes:
o mediastinal: < 10mm in short axis
o retro-crural: < 6mm in diameter
22. ovarian follicle: < 2.5-3 cm
23. ovaries: volume:
o pre-menopausal: < 18 cc
o post-menopausal: < 8 cc
24. paraspinal lines:

2
 o left: < 10 mm wide
o right: < 3 mm wide
25. paratracheal stripe: < 5 mm
26. portal vein: < 13 mm diameter
27. prevertebral soft tissue thickness (lateral c-spine x-ray):
o 7mm at C2
o 2cm at C7
o easiest way to remember is "7 at 2 and 2 at 7"
28. prostate volume: < 25 - 30 cc
29. pulmonary artery:
o descending branch of right pulmonary artery: < 16 mm (males), < 15 mm (females)
o main pulmonary artery: < 29 mm
30. rectum: wall thickness < 5mm
31. scapholunate angle: 30 - 60o
32. small bowel:
o lumen: < 3 cm
o wall: < 3 mm
33. spleen: < 12 cm
34. splenic vein: < 10 mm diameter
35. testis:
o vein: < 2 mm diameter
o size: < 5 x 3 x 3 cms (volume: 12.5-19 cc)
36. thyroid: < 2 cm anteroposterior dimension
37. trachea:
o chest x-ray: < 25 mm (males) , < 21 mm (females)
38. ureter: 30-34 cm long, 2-8 mm diameter
39. uterus:
o prebuscent: length up to 3cm, diameter around 1cm
o nulliparous: length up to 8cm, diameter around 8cm
o multiparous: length up to 9.5cm, diameter around 5.5cm
o postmenopausal: length up to 6cm, diameter around 2cm
40. uterine cervix: diameter less than 3cm.
***

ADULTS

3
ABDOMEN
LIVER ▪Liver size ≤17cm in CC dimension
▪Biliary
▫Intrahepatic ducts ≤2mm
▫Normal CBD ≤6mm (≤60yo): add 1mm per decade over 60yo
▫Post-cholecystectomy CBD up to 1cm
▫Pediatrics CBD <4mm
GB ▪Gallbladder size
▫Wall <3mm
▫Diameter ≤4cm
▫Length <10cm
▪GB polyp ≥5mm consider follow up (≥1cm may consider surgery)
SPLEEN ▪Spleen size ≤13cm length (usually <7cm in width)
▪Splenic artery aneurysm ≥2.0-2.5cm consider endovascular therapy
PANCREAS ▪Pancreas size
▫Head width ≤3cm
▫Body width ≤2.5cm
▫Tail width ≤2.5cm
▪Pancreatic duct (≤3mm adults and up to 5mm in elderly patients)
▫Head ≤3mm
▫Body ≤2mm
▫Tail ≤1mm
ADRENALS ▪Adrenal size
▫limb length <5cm
▫limb width <7mm
KIDNEYS ▪Renal size
▫Length 9-12cm
▫Cortical thickness ≥1cm
▪Asymmetric renal length difference ≥1.5cm is usually significant
▪Renal artery aneurysm ≥2cm consider endovascular repair
BLADDER ▪Wall thickness: <4mm when distended and <8mm post-void
▪Post-void residual volume >100-150cc may need intervention
MISC ▪Normal ecogenicity of pancreas > spleen > liver > kidneys
▪Appendix <6mm and compressible is normal
▪Hypertrophic pyloric stenosis if pyloric muscle thickness >3mm and
channel length >14mm
▪Visceral artery aneurysm ≥2cm
▪Normal anal sphincter muscle thickness 4mm

FEMALE PELVIS ULTRASOUND

OVARIES

4
SIZE NORMAL
▪ Pre-menopausal 5x3x2cm (volume 9cc for nulliparous and 15cc for
multiparous)
▪ Post-menopausal 2.5x2x2cm
▪ Pediatrics
▫ 6yo ~1cc
▫ Pre-pubertal (6-10yo) 1.2-2.3cc
▫ Pre-menarchal (11-12yo) 2-4cc
▫ Post-menarchal >2.5-18cc

ABNORMAL
▪ Pre-menopausal >18cc volume
▪ Post-menopausal >8cc volume

Note: volume = (L x H x W x 0.5)

SIMPLE APPEARANCE
CYST ▪ Circumscribed margins
▪ Posterior acoustic enhancement
▪ No internal echoes

PRE-MENOPAUSAL FOLLOW-UP
▪ Cyst ≤3cm (physiologic developing/dominant follicle; no f/u needed and
do not have to describe)
▪ Cyst >3 and ≤5cm (mention but no f/u needed)
▪ Cyst >5cm and ≤7cm (yearly f/u)
▪ Cyst >7cm (further evaluation with MR or consider surgery)

POST-MENOPAUSAL FOLLOW-UP
▪ Cyst ≤1cm (inconsequential)
▪ Cyst >1cm and ≤7cm (almost certainly b9 but yearly f/u with u/s at least
initially)
▪ Cyst >7cm (further evaluate with MR or consider surgery)

HEMORR. APPEARANCE
CYST ▪ Reticular pattern (“fishnet”) of internal echoes
▪ May have ecogenic clot w/o flow

FOLLOW-UP
▪ Cyst ≤3cm (no f/u needed)
▪ Cyst >3 and ≤5cm (describe but no f/u needed)
▪ Cyst >5cm (f/u u/s in 6-12wks to ensure resolution; image on day3-10 of
menses)

ENDOMET- APPEARANCE
RIOMA ▪ Homogenous low level internal echoes

5
 FOLLOW-UP
▪ Short-term f/u initially in 6-12wks to exclude hemorrhagic cyst
mimickers, then yearly if no surgical removal
▪ Malignancy risk ~1% (endometroid or clear cell CA) if >9cm (not if
<6cm) and age >45yo

DERMOID APPEARANCE
▪ Focal ecogenic plug with acoustic shadowing
▪ Hyperechoic lines and dot internal echoes

FOLLOW UP
▪ F/u in 6-12mos interval regardless of age if no surgical removal
▪ Malignancy risk ~2% (SCC) if >10cm and age >50yo
COMPLEX INDETERMINATE BUT PROB B9
CYST ▪ Single cyst but w/ single thin septa <3mm or small wall calcification
▪ FOLLOW UP: use same f/u as simple cyst by size & age

INDETERMINATE BUT NOT HEMORRHAGIC / ENDOMETRIOMA

/ DERMOID
▪ Multiple septations <3mm
▪ Solid nodule w/o flow
▪ Focal wall thickening
▪ FOLLOW UP:
▫ Size>10cm (13% chance of malignancy so surgery is recommended)
▫ Pre-menopausal (6-12wks f/u; if persists, consider MR w/ gad and if
not hemorrhagic
cyst or endometrioma or dermoid, do surgery)
▫ Post-menopausal (surgery)

WORRISOME FOR MALIGNANCY

▪ Thick septa ≥3mm
▪ Solid nodule w/ flow
▪ Focal wall thick ≥3mm
▪ FOLLOW UP: no f/u; surgery recommended
CORPUS APPEARANCE
LUTEUM ▪ Thick crenulated wall
▪ Small cystic center
▪ May have surrounding “ring-of-fire” flow

FOLLOW UP
▪ No f/u needed if size ≤3cm
PCO Polycystic Ovaries

APPEARANCE
▪ >10-12 peripheral follicles bilaterally
▪ Hyperechoic/hypervascular central stroma

6
 ▪ Ovarian volume >15cc
OHSS Ovarian HyperStimulation Syndrome

APPEARANCE
▪ Bilateral enlarged ovaries >5-10cm in diameter
▪ Numerous thin-walled cysts >1cm
▪ May have ascites and pleural effusion
UTERUS
SIZE NORMAL
▪Pre-menopausal 9x5x5cm
▪Post-menopausal 7x2x2cm
▪Pediatrics
▫Neonate (<1mo old) 4x2x2cm
▫Pre-pubertal child 3x1x1cm
▫Post-pubertal child 8x3x3cm
EMS EndoMetrial Stripe

NORMAL
▪Pre-menopausal ≤15mm
▫Menses (day 1-5) <4mm
▫Proliferative phase (day6-10) 4-8mm
▫Secretory phase (day14+) ≤15mm
▪Post-menopausal
▫Without bleeding (or on Hormone Replacement) ≤8mm
▫With bleeding ≤5mm

ABNORMAL
▪Post-menopausal atrophy <3mm
▪Post-partum retained products of conception (RPOC) >5mm (<2mm
RPOC unlikely)
▪DDX for thickened EMS= secretory phase; pregnancy; retained POC,
hyperplasia; polyp; CA; Tamoxifen
PELVIS
FREE ▪Physiologic ~10cc in (may increase during ovulation)
FLUID
PELVIC ▪Pelvic veins >4-5mm in diameter
CONGEST- ▪Slow flow ~3cm/s
ION ▪Tortuous dilated pelvic venous plexuses and arcuate veins
▪Associated with dyspareunia
PROSTATE ▪Normal volume ~30cc

THYROID ULTRASOUND

THYROID

7
SIZE NORMAL
▪Lobe length 4-6cm
▪Lobe diameter 1.3-1.8cm
▪Isthmus AP <1cm
▪Volume 20cc (+/- 5cc) males and 18cc (+/- 4cc) females

GOITER
▪Volume >25g
NODULES LIKELY B9 FEATURES
▪Colloid cyst (cyst with bright echoes or avascular colloid clot)
▪Predominantly cystic nodule (without internal flow)
▪Spongiform nodule
▪Giraffe pattern
▪Diffusely hyperechoic nodule (especially if multiple)

SUSPICIOUS FEATURES
▪Micro-calcifications (highest specificity)
▪Diffusely hypoechoic solid nodule
▪Irregular/infiltrative margins
▪Taller than wide (larger AP dimension on transverse view)
▪Chaotic internal flow
▪Associated cervical adenopathy

HIGH RISK HISTORY

▪Thyroid cancer in first degree relative(s)
▪External beam radiation as a child
▪Exposure to ionizing radiation as a child
▪PET avid thyroid nodule
▪MEN2 syndrome
▪Familial Medullary thyroid carcinoma associated gene mutation

SIMPLIFIED NODULE GUIDELINE

▪Nodule <1cm without suspicious features or high risk history = consider
6mos follow up
▪Nodule >5mm with suspicious features or high risk history = consider FNA

SIGNIFICANT GROWTH OF NODULE

▪Increase in volume by 50%
▪Increase in diameter by 20% within at least 2mm increase in two or more
dimensions
▪Growth of mixed solid/cystic nodule is judged by growth of solid
component

TESTICULAR ULTRASOUND

8
TESTIS
SIZE NORMAL TESTIS
▪Length up to 5cm
▪Width up to 4cm

NORMAL EPIDIDYMIS
▪Head 1.0-1.2cm
▪Body/tail 2.0cm
PATHOLOGY VARICOCELE
▪Dilated pampiniform plexus >3mm upon valsalva

MICROLITHIASIS
▪More than 5 micro-calcifications on a single image
▪Yearly follow up may be considered

OBSTETRICS (OB) ULTRASOUND

OB
VIABILITY VIABILITY CRITERIA
▪MSD >25mm (endovaginal) = should see Y-sac and embryo
▪CRL ≥7mm (endovaginal) or ≥15mm (transabdominal) = should have heartbeat

FOLLOW-UP OF PREGNANCY OF UNKNOWN VIABILITY

▪If see G-sac but no Y-sac followup in 2wks or more absence of embryo
with a heartbeat is diagnostic of pregnancy failure
▪If see G-sac with Y-sac but no embryo followup in 11 days or
more absence of embryo with a heartbeat is diagnostic of pregnancy failure

EARLY PREGNANCY US IMPRESSIONS

▪Viable IUP
▪IUP of unknown viability (+/- suspicious for pregnancy failure)
▪Pregnancy of unknown location (if normal appearing endometrium ddx= early
IUP vs occult ectopic vs completed spontaneous abortion; if abnormal appearing
endometrium ddx= spontaneous abortion in progress vs indeterminate
intrauterine fluid collection)

▪Non-viable IUP

TIPS
▪G-sac appears at 4.5-5.0 wks (intradecidual sign or double sac sign)
▪Y-sac appears at 5.0-5.5 wks (normal size 3-5mm)
▪Embryo appears ~6.0 wks
▪Amnion usually seen at 7.0 wks

9
 QUANTITATIVE Beta HCG
▪HCG>1000 = generally see gestational sac
▪HCG>7000 = generally see Y-sac
▪HCG>11,000 = generally see embryo

POOR PROGNOSIS (SUPICIOUS FOR PREGNANCY FAILURE)

▪Empty amnion (no embryo)
▪Sustained bradycardia <80bpm
▪Small MSD relative to CRL (<5mm difference btwn MSD and CRL)
▪Enlarged Y-sac >7mm
▪Low-lying gestational sac
▪Subchorionic hemorrhage ≥40% of gestational sac volume
▪Thin poorly-ecogenic decidua

ANATOMY SOFT MARKERS

▪Choroid plexus cyst(s) ≥3mm
▪Ecogenic intracardiac focus (as bright as bone)
▪Ecogenic bowel
▪Nuchal fold thickness ≥6mm
▪Pyelectasis ≥4mm (2nd trimester) and Persistent pyelectasis ≥7mm (3rd
trimester)
▪Single vessel cord (single umbilical artery)
▪Ventriculomegaly ≥1cm

BIOMETRY
▪Use biometry for CRL >6cm
▪In 2nd trimester, single best measure of GA is HC (others further improve
prediction)
▪In 3rd trimester, single best measure of GA is FL (more reproducible than AC)
▪AC is least predictive of GA but most useful for EFW determination esp in
3rd trimester
▪Flattened head (dolicocephaly) or rounded head (brachycephaly) are normal
variants (HC more reliable than BPD for GA)
▪Disproportionally small HC <3 SDs below mean for GA = microcephaly

NORMAL ANATOMIC MEASUREMENTS

▪Nuchal translucency (1st trimester) <3mm
▪Nuchal fold thickness (2nd trimester) <6mm
▪Choroid plexus cyst <3mm (≥3mm is abnormal)
▪Ventricles <1cm (Ventriculomegaly ≥1cm)
▪Trans-cerebellar diameter correlates in mm with gest age in mm upto 20wks (ie
20mm at 20wks; usually larger after 20wks; abnormal if 2mm less than gest age)
▪Cisterna magna 2-10mm
▪Nasal bone length ≥4mm (2.5th percentile is 4.4mm at 18wks and 5mm at
20wks)—look for hypoplastic or absent nasal bone
▪Fetal cardiac activity 100-180bpm (bradycardia <80-100 bpm)

10
 ▪Ecogenic intracardiac focus is significant if as bright as bone (be aware of
normal variant moderator band within RV)
▪Renal length symmetric 20-22mm in length
▪Renal pelvis <4mm (Pyelectasis if ≥4mm in 2nd trimester; Persistent pyelectasis
if ≥7mm in 3rd trimester)
▪3 vessel cord with 2 umbilical arteries (2 vessel cord = single umbilical artery)

PLACENTA/CERVIX
▪Placental thickness 1-4cm (<4cm in thickness)
▪Inferior placental tip should be >2cm from internal os of cervix (otherwise,
consider low-lying placenta vs placenta previa)
▪Cervical length ≥2.5cm and closed (otherwise consider incompetent cervix and
look for funneling)

GROWTH GROWTH ASSESSMENT

▪Fetal scan for growth assessment should be down at least 2 weeks apart
▪Estimated fetal weight (EFW) within 10th to 90th percentile for gestational age
▫Macrosomia >90th percentile or >4000-4500g (also look for polyhydramnios)
▫SGA (small for gestational age) <10th percentile or <2500g at term
▫IUGR= SGA + AC <2.5th percentile (size<dates) do cord doppler
▫Asymmetric IUGR (high HC:AC ratio; possible placental insufficiency)
▫Symmetric IUGR (normal HC:AC ratio; constitutionally small baby or
genetic/chromosomal abnormality or TORCH infection or
maternal ETOH)
▫Check AFI (oligohydramnios can be seen with IUGR)
▪Large for gestational age (LGA) if 3rd trimester dates >2wks compared to
clinical dates

AMNIOTIC FLUID
▪Amniotic fluid index (AFI) 5-20cm
▫Polyhydramnios >20-25cm (single max vertical pocket depth >8cm)
▫Oligohydramnios <5cm or <5th percentile (single max vertical pocket depth
<2cm)

CORD & MCA DOPPLER

▪Fetal cord Doppler (assess umbilical arterial waveform for
reduced/absent/reversed diastolic flow and corresponding abnormal resistive
index)
▪Fetal MCA Doppler (assess fetal middle cerebral artery S/D ratio which is
normally greater than umbilical artery S/D ratio)

11
FETAL ANATOMIC SURVEY CHECKLIST FOR 2nd TRIMESTER ULTRASOUND

12
13
 VASCULAR ULTRASOUND

VASCULAR
AORTA ABDOMINAL AORTA
▪Ectasia 2.5-2.9cm
▪Aneurysm ≥3cm
CAROTIDS ICA STENOSIS
▪NORMAL or STENOSIS <50%
▫PSV <125cm/s
▫ICA/CCA ratio <2
▫ICA EDV <40cm/s
▪STENOSIS 50-69%
▫PSV 125-230cm/s
▫ICA/CCA ratio 2-4
▫ICA EDV 40-100cm/s
▪STENOSIS ≥70%
▫PSV >230cm/s
▫ICA/CCA ratio >4
▫ICA EDV >100cm/s
RAS RENAL ARTERIAL STENOSIS CRITERIA
▪Renal artery PSV >200cm/s
▫EDV >150m/s suggests >80% stenosis
▫RI >0.8 predicts response to renal vascularization
▪Renal artery to aortic PSV ratio >3.5
▪Intra-renal arterial systolic rise (acceleration time) ≥0.07s (parvus-tardus)
TIPS TIP SHUNT DYSFUNCTION
▪Intra-shunt PSV <50-60m/s or >200-250m/s
▪Change in PSV of +/- 50m/s compared to baseline scan
▪Decrease in PSV by <2/3rd (66% less than) compared to baseline scan
▪Hepatofugal flow within main portal vein
PAD PERIPHERAL ARTERIAL DISEASE CRITERIA
▪Mild stenosis (1-19%)
▫Distal-to-proximal PSV ratio <2:1
▫Triphasic waveform
▪Moderate stenosis (20-49%)
▫Distal-to-proximal PSV ratio <2:1
▫Biphasic waveform
▪Severe stenosis (50-99%)
▫Distal-to-proximal PSV ratio >2:1 (>4:1 suggest >70%; >7:1 suggest
>90%)
▫Monophasic waveform

PERIPHERAL ARTERIAL GRAFT ASSESSMENT

▪Minimal graft stenosis (<20%)

14
 ▫Distal-to-proximal PSV ratio <1.4
▫PSV <125cm/s
▪Moderate graft stenosis (20-50%)
▫Distal-to-proximal PSV ratio 1.5-2.4
▫PSV <180cm/s
▪Significant graft stenosis (50-75%)
▫Distal-to-proximal PSV ratio 2.5-4.0
▫PSV >180cm/s
▪High-grade graft stenosis (>75%)
▫Distal-to-proximal PSV ratio >4.0
▫PSV >300cm/s

PERIPHERAL ART STENOSIS AFTER PERC REVASCULARIZATION

▪Distal-to-proximal PSV >2
▪PSV >180cm/s

PEDIATRIC MEASUREMENTS

Splenic length no greater than 6.0 cm at 3 months, 6.5 cm at 6 months, and 7.0 cm at 12 months,
8.0 cm at 2 years, 9.0 at 4 years, 9.5 cm at 6 years, 10.0 cm at 8 years, 11.0 cm at 10 years, 11.5
cm at 12 years, 12.0 cm at 15 years or older for girls, and 13.0 cm at 15 years or older for boys.

Gastrointestinal Measurements
Appendix
Normal Appendix

Modality Transverse Diameter (mm) Appendiceal Wall Thickness (mm)

US < 6 (& compressible) Usually < 2

CT <8 <2-4

Gallbladder and Biliary Tract

Sonographic Measurements of the Normal Pediatric Gallbladder and Biliary Tract

15
Normal Gallbladder Measurements vs. Age 1

Age AP AP Coronal Coronal Length Length Wall Wall

Diameter Diameter Diameter Diameter Thickness Thickness
Mean Range Mean Range Mean Range Mean Range
(y) (cm) (cm) (cm) (cm) (cm) (cm) (mm) (mm)

0-1 0.9 0.5-1.2 0.9 0.7-1.4 2.5 1.3-3.4 1.7 1.0-3.0

2-5 1.7 1.4-2.3 1.8 1.0-3.9 4.2 2.9-5.2 2.0 None

6-8 1.8 1.0-2.4 2.0 1.2-3.0 5.6 4.4-7.4 2.2 2.0-3.0

9-11 1.9 1.2-3.2 2.0 1.0-3.6 5.5 3.4-6.5 2.0 1.0-3.0

12-16 2.0 1.3-2.8 2.1 1.6-3.0 6.1 3.8-8.0 2.0 1.0-3.0

Normal Sonographic Common Hepatic Duct Sizes vs. Age 1

Age (y) Common Hepatic Duct Size Mean (mm) Common Hepatic Duct Size Range (mm)

0-1 1.3 1.0-2.0

2-5 1.7 1.0-3.0

6-8 2.0 none

9-11 1.8 1.0-3.0

12-16 2.2 1.0-4.0

GI Tract

16
Normal GI Tract: Wall Thickness on CT

Organ Wall Thickness (mm)

Stomach 3-5

Duodenum ≤3

Colon ≤3

Lymph Nodes on CT
Normal Abdominal Lymph Nodes in Adolescents and Adults:CT¹

Location Short Axis Nodal Diameter (mm)

Retrocural ≤6

Paracardiac ≤8

Mediastinal < 10²

Gastrohepatic ligament ≤8

Upper paraaortic ≤9

Portacaval ≤ 10

Portahepatis ≤7

Lower paraaortic ≤ 11

Pancreas & Pancreatic Duct

17
Normal Pancreas Size as a Function of Age (Ultrasound)*¹

Age Head in cm (± 1 SD) Body in cm (± 1 SD) Tail in cm (± 1 SD)

< 1 month 1.0 ± 0.4 0.6 ± 0.2 1.0 ± 0.4

1 month to 1 year 1.5 ± 0.5 0.8 ± 0.3 1.2 ± 0.4

1 to 5 years 1.7 ± 0.3 1.0 ± 0.2 1.8 ± 0.4

5 to 10 years 1.6 ± 0.4 1.0 ± 0.3 1.8 ± 0.4

10 to 19 years 2.0 ± 0.5 1.1 ± 0.3 2.0 ± 0.4

*Measured as maximum AP on transverse scan

The normal pancreatic duct is less than 2 mm in diameter

Computed Tomography: The craniocaudal dimension of the head ranges from 2 to 6 cm, while
the body and tail ranges from 2 to 4 cm.2

Portal Vein

18
Normal Main Portal Vein Size on Ultrasound as a Function of Age

Age Main Portal Vein Transverse Diameter (mm)

<10 years 8.5 ± 2.7

10 to 20 years 10 ± 2

Pylorus

Muscle thickness < 3.0 mm Pyloric channel length < 17mm

Muscle wall thickness: measured as a single hypoechoic layer between serosa and echogenic
submucosa. (muscle thickness exaggerated for illustration)

NOTE: PRETERM INFANTS. Borderline muscle thickness measurements are more likely to
occur in premature infants than in term infants. In preterm infants, the thickness of the pyloric
muscle relative to the rest of the stomach and the pyloric canal length is more important than the
absolute muscle thickness.

Spleen

19
Ultrasound: Normal Spleen Size vs. Age¹

Age Spleen Length (cm)*

0-3 months ≤6

3-6 months ≤ 6.5

6-12 months ≤7

1-2 years ≤8

2-4 years ≤9

4-6 years ≤ 9.5

6-8 years ≤ 10

8-10 years ≤ 11

10-12 years ≤ 11.5

12-15 years ≤ 12

15-20 years (female) ≤ 12 (female)

15-20 years (male) ≤ 13 (male)

*Measurement obtained in the coronal longitudinal plane

20