BASIC ABDOMINAL ULTRASOUND

DR. UKACHUKWU I. H.
MBBS (IBADAN), FWACS (RADIOLOGY),
CERT. INTERV. RADIOLOGY (GERMANY)
 OUTLINE
 INTRODUCTION - PHYSICS AND KNOBOLOGY
 ULTRASOUND ANATOMY
 BASIC LIVER USS
 BASIC SPLEEN USS
 BASIC RENAL USS
 BASIC PANCREAS USS
 BASIC INTESTINAL USS
 CONCLUSION
 INTRODUCTION
 SONAR – Sound Navigation &
Ranging
 Range of frequencies in
diagnostic application is 2 – 20
MHz
 B-Mode, M-Mode, Duplex,
 B -Gain, TGC, Depth, Focus, Zoom
 Invert, Reject/Supression,
SonoCT,
 Artifacts – Reverbration, Mirror
Image, Shadowing, Enhancement,
Mirror Image
 ULTRASOUND ANATOMY
 Size
 Shape
 Echogenicity -Isoechoic, Hypoechoic, Hyperechoic
 Echotexture -Coarse, homogenous, Heterogenous
 Margins
 Origin
 Composition – Solid, cystic, Complex, Air,
 BASIC LIVER SCAN
 Normal liver parenchyma – hyerechoic to Kidney and
hypoechoic to normal pancreas & spleen.
 Homogenous mid gray to mild echogenic parenchyma
 Portal and Hepatic veins display anechoic tubular branching
structures . PV has bright echogenic walls.
 Diaphragm, Ligament & Fissures of the liver appear highly
relective
Couinaud Segment
 Fatty infiltration, Cirrhosis, Chronic Hepatitis,
Chronic RHF, AIDS, GSD, Gauchers, Wilsons
 Hepatic Adenoma

 Metastasis
- Hypoechoic
Lymphoma,
primary
malignancy
- Hyperechoic
Colonic ca, GIT Ca,
- Cystic : Ovarian, GI
sarcomas
 HCC

 Irregular hypoechoic
mass
 Amebic abscess. Sagittal view shows a well-
defined, hypoechoic amebic abscess
containing diffuse internal echoes and
posterior acoustic enhancement.
 Transverse view: two well-defined,
hypoechoic amebic abscesses containing
low-level internal echoes.
 Gall Bladder

 Long

 Trans
 GALL BLADDER
 Cholelithiasis
 Calcium / Cholesterol
stones
Acute
Cholecystitis
 Cholecystitis thickened
wall >3mm
 Dilated GB
 Pericholestic fluid/edema
 Sonographic Murphy’s sign
 Increased Wall Color flow
 Gall stones / Sludge
Emphysematous Cholecystitis

 Elderly, DM,
 1% of Cholecystitis
 Vascular compromise of GB wall by Gas
forming organism-Clostridium spp., Ecoli,
Step., Staph.
 Curvilinear echogenic areas in the Gall
bladder wall, the reverbration artefacts are
diagnostic
 Obscuration of the gall bladder by high level
echoes
Biliary duct Obstruction
 Dilated intrahepatic ducts
SPLEEN
 Splenomegaly with siderotic nodules
RENAL SCAN
Nephrolithiasis

 Renal Calculi

 Renal Calculi +
 Grade I
Hydronephrosis
 Renal Cyst
Pancreas
INTESTINAL USS

 Gross Ascites

 Gross Ascites with

low level echoes
Appendicitis
 2 views Short & Long
axis
Appendicitis
 Above 6mm
 Non compressible
 Increased color flow
 Appendicolith
 Segmental in 20 %
 Tenderness to Probe
Appendicitis

 Edema & Fat strandingn-echogenic fat

 Distension of the lumen
 Fluid collection – perforated apppendix
 Abscess
 Gas filled appendix
 Right lower Quadrant pain.
 DDX – Mesenteric lymphadenitis, ovarian
cyst,
 CONCLUSION
 Clinical Knowledge—knowing what to look for and
why, knowing how to interpret the appearances on the
image and an understanding of physiological and
pathological processes.
 Technical skill— knowing how to obtain the most
useful and relevant images, knowledge of artifacts and
avoiding the pitfalls of scanning.
 Knowledge of the equipment being used—making
the most of your machine