basic technique of liver sonography , basic anatomy review of the liver , few pathological conditions as depicted by ultrasound scanning

1. ULTRASOUND OF THE LIVER
Dr.Tayseer jamal Aldeen , Radiologist
Dr.Tayseer Jamal Aldeen , Radiologist

2. Indications of abdominal ultrasound
1) Abdominal pain
2) Abdominal mass
3) Jaundice ,
4) Abdominal trauma
5) Searching for metastasis
Dr.Tayseer Jamal Aldeen , Radiologist

3. EQUIPMENT SELECTION
 Ultrasound machines should be capable of standard
real-time imaging, have color, power, and spectral
Doppler abilities, and be capable of providing
diagnostic images for interpretation by a certified
interpreting physician.
 Curved transducers and/or linear transducers are
commonly utilized for abdominal and retroperitoneal
sonography
 For adults frequrncy transducer = 4-6 MHz
 For pediatric usually higher than 5 MHz frequency
transducer is used.
 Higher frequencies, including the use of a linear transducer,
are often used and needed when evaluating the abdominal
wall, liver surface, and bowel.
Dr.Tayseer Jamal Aldeen , Radiologist

4. Common Sono-terminology
Dr.Tayseer Jamal Aldeen , Radiologist

5. PATIENT POSITIONING FOR ABDOMINAL SONOGRAPHY
 Most often, abdominal sonographic imaging is initially conducted in the supine position.
 Other patient positions may be utilized throughout the exam, including upright and decubitus
positioning
Dr.Tayseer Jamal Aldeen , Radiologist

6. Complete abdominal sonogram protocol
Dr.Tayseer Jamal Aldeen , Radiologist
 The assessment can be performed in the following manner with patient in the supine position
initially:
 Pancreas
 Liver
 Gallbladder and biliary tree
 Right kidney
 Aorta and IVC
 Spleen
 Left kidney
 Decubitus examination of the gallbladder and biliary tree

7. Right upper quadrant protocol
Dr.Tayseer Jamal Aldeen , Radiologist
 The assessment can be performed in the following manner with patient in the
supine
 position initially:
 Pancreas
 Liver
 Gallbladder and biliary tree
 Right kidney
 Decubitus examination of the gallbladder and biliary tree

8. Liver
Dr.Tayseer Jamal Aldeen , Radiologist
 ESSENTIAL ANATOMY AND PHYSIOLOGY OF THE LIVER
 The liver has three main lobes: right, left, and caudate.
 Right lobe:
 Located mostly on the right side of the abdomen.
 Separated into anterior and posterior segments by the right hepatic vein.
 Left lobe:
 Located mostly in the midline.
 Separated into medial and lateral segments by the left hepatic vein.
 Caudate lobe:
 Located in the midline, posterior to the left lobe.
 Bordered anteriorly by the ligamentum venosum and posteriorly by the IVC

9. Dr.Tayseer Jamal Aldeen , Radiologist
 The main portal vein is created from the union of the
superior mesenteric vein and splenic vein.
 The main portal vein enters the liver, bringing blood from
the mesentery and other organs, and branches into right
and left portal veins.
 The left portal vein branches into medial and lateral
tributaries.
 The right portal vein branches into anterior and posterior
tributaries.
 The right, middle, and left hepatic veins drain into the IVC
.
 The hepatic artery is a branch of the celiac trunk.

10. PATIENT PREPARATION
Dr.Tayseer Jamal Aldeen , Radiologist
 Patient preparation is focused on eliminating bowel gas and
having the potential of a fully distended gallbladder at the time of
the examination.
 NPO for 6–8 hrs is optimal, (Nothing Per Os)
 If the examination is performed without fasting, proper
documentation should take place.

11. SUGGESTED EQUIPMENT
Dr.Tayseer Jamal Aldeen , Radiologist
 3–5-MHz transducer (higher frequencies can be used for thin
patients)
 General abdominal setting (most machines)

12. NORMAL SONOGRAPHIC DESCRIPTION OF THE LIVER
Dr.Tayseer Jamal Aldeen , Radiologist
 The liver should be homogeneous and slightly more echogenic than or equal to that of the right
kidney.
 The liver is typically isoechoic or more hypoechoic to the normal spleen.
 The normal liver parenchyma is occasionally interrupted by anechoic vascular structures.

13. SUGGESTED PROTOCOL FOR SONOGRAPHY OF THE LIVER
Dr.Tayseer Jamal Aldeen , Radiologist
 Survey the liver in transverse or longitudinal:
 Ask the patient to extend his or her right arm up above his or her head in order to
 expand the intercostal spaces.
 With the patient in the supine position, obtain a brief survey of the liver by scanning superiorly
and inferiorly (transverse) or medially and laterally (longitudinal).

14. Dr.Tayseer Jamal Aldeen , Radiologist
 Longitudinal liver Scan :
1) Assess the left lobe in the midline of the body and provide images of the left lobe
by scanning medially and laterally.
2) Image the caudate lobe
3) Position the transducer on the patient’s right side and assess the right lobe of
the liver. Provide a liver–kidney interface image assess for fluid in the right
subhepatic space (Morrison pouch)

15. Dr.Tayseer Jamal Aldeen , Radiologist
<<right lobe
left lobe >>
liver-kidney interface

16. Dr.Tayseer Jamal Aldeen , Radiologist

17. Dr.Tayseer Jamal Aldeen , Radiologist
 Transverse liver Scan :
1) Assess the left lobe and caudate lobe in the midline of the body
2) Position the transducer on the patient’s right side and assess the right lobe of
the liver.
3) Provide images of the hepatic veins and IVC .
4) Provide images of the portal veins and their branches

18. Dr.Tayseer Jamal Aldeen , Radiologist

19. SCANNING TIPS
Dr.Tayseer Jamal Aldeen , Radiologist
 Deep, sustained inspiration can be helpful to
assist in the visualization of the complete liver
in most individuals.
 Right lateral decubitus positioning can be
helpful.
 NORMAL MEASUREMENTS OF THE LIVER
 Midhepatic or midclavicular line = <15
cm

20. Dr.Tayseer Jamal Aldeen , Radiologist
 Liver measuremnets

21. ESSENTIAL LIVER PATHOLOGY
Dr.Tayseer Jamal Aldeen , Radiologist
 Hemangioma

22. Dr.Tayseer Jamal Aldeen , Radiologist
 Hepatic cyst

23. Dr.Tayseer Jamal Aldeen , Radiologist
Fatty liver

24. Dr.Tayseer Jamal Aldeen , Radiologist

25. Dr.Tayseer Jamal Aldeen , Radiologist
Thank you