general anatomy review and sonographic anatomy

1. SONOGRAPHIC ANATOMY
OF ABDOMINAL AND
PELVIC ORGAN
DR.MANISH YADAV
RESIDENT
NAIHS

2. OBJECTIVES
Review
normal
anatomy
Know
sonographic
anatomy and
appearance Sonographic
measurements

3. ULTRASOUND NOMENCLATURE
• Anechoic: no echoes, appears black on screen- gall bladder,
urinary bladder, vascular structure, cyst
• Hypoechoic: less reflective and less amount of echoes, appears
gray on screen- prostate, medullary pyramids, LN
• Hyperechoic: highly reflective and echo rich, appears white/light
gray- bone, diaphragm, calculus
• Isoechoic: having similar echogenicity to neighbouring structure
• Homogenous: organ parenchyma uniform in echogenicity
• Heterogenous: organ parenchyma not uniform in echogenicity

4. LIVER
•Largest abdominal viscera
•Division :
- Morphological :Right and left lobes
- Functional : Eight segments

5. MORPHOLOGICAL

6. COUINAUD CLASSIFICATION
• Divides liver functionally into eight segments
• Each segments has its own vascular supply and biliary
drainage

7. SONOGRAPHIC ANATOMY:LIVER
• Normal liver is homogenous
and contain fine level of
echoes
• Portal veins have echogenic
wall
• Hepatic veins have
imperceptible wall

8. • Echogenicity compared with renal cortex and spleen
-minimally hyperechoic or isoechoic than renal cortex
-hypoechoic than spleen
• Mean longitudinal diameter in MCL :10.5 cm +/- 1.5 SD
• Normal range in adults :9 to15 cm
• Main portal vein : <12 mm in diameter
• Hepatic vein: < 6.2 mm

9. SONOGRAPHIC VIEW : LIVER

10. HEPATIC VEINS

12. GALL BLADDER
• Flask shaped, blind ending diverticulum attached to the
bile duct by cystic duct
• Lies in the inferior margin of liver between segments IV
and V
• Parts : fundus, body and neck
• Phrygian cap: anatomic variant created due to folding of
fundus on its body

13. SONOGRAPHIC ANATOMY
• Appearance: pear
shaped, anechoic
structure with well defined
hyperechoic wall
• Size:
-length: 7 to 10 cm
-width: 2.5 to 4 cm
-height: 2.75 cm
• Wall thickness: <3 mm

14. PHRYGIAN CAP

15. BILIARY TREE
• System of ducts that
collect and deliver bile
from liver to second part
of duodenum
• Parts:
-intrahepatic
-extrahepatic
• Size: (diameter)
-CHD/CBD: <6 mm
-first order branches: <2mm

17. BILIARY DILATATION
• Mean diameter of CBD in pediatrics group increases
gradually
- Neonate: 1.2 mm
- 17 year: 2.3 mm
• Biliary dilatation in pediatrics group without symptoms and
other sonographic/ lab abnormality shows benign clinical
course
• Widening of duct with increasing age in old age:
controversial
• After cholecystectomy there is slight physiological dilatation
of duct, most case 1-3 mm over baseline

18. PANCREAS
• Sits behind the stomach
• Lies transversely across
posterior abdominal wall
at the level of L2 and L3
• Parts: head, uncinate
process, neck and tail

19. SONOGRAPHIC ANATOMY
• Shape, size and
echogenicity varies
considerably
• Echogenicity is usually iso
to hyperechoic compared
with liver parenchyma
• Size: (diameter)
-head: 0.6 to 2.8 cm
-body: 0.4 to 2.3 cm
-tail: 5 to 2.5 cm

20. KIDNEYS
• Located retroperitoneally
in the posterior abdominal
wall on either side of
vertebral column
• Bean shaped
• Renal parenchyma:
cortex and medullary
pyramids
• Size:
-length: 8 to 12 cm
-width: 4 to 6 cm
-thickness: 2.5 to 3.5

21. SONOGRAPHIC ANATOMY
• Echogenicity
-capsule: smooth, echogenic
line around kidney
-cortex: typically less
echogenic than liver
-medulla: hypoechoic than
cortex
-sinus: hyperechoic

22. SPLEEN
• Appear inverted comma
shape
• Splenic parenchyma is
homogenous
• Echogenicity is higher as
compared to liver
• Size:
-length (l) : 9 to12 cm
-width (w) : 7 cm
-thickness (t) : 5 cm

23. URINARY BLADDER
• Best evaluated when
moderately filled
• Appear as anechoic
structure with echogenic,
thin smooth walled almost
rectangular shape
• Wall thickness:
-fully distended: < 3mm
-nondistended: < 5mm

24. PROSTATE
• Lies between bladder neck and urogenital diaphragm
• Appear homogenous, hypoechoic and bounded by
capsule
• Size:
-AP: 3 to 4 cm
-width: 2 to 3 cm
-craniocaudal: 3.5 to 5 cm
• Volume: < 25 gm

26. UTERUS
• Thick walled, pear shaped, hollow muscular organ
• Parts: fundus, body and cervix
• Position: most frequently anteverted – anteflexed
• Size: varies depending on patient age and gravidity
- length: 4.5 to 9 cm
- AP diameter : 1.5 to 3 cm
- transverse: 4.5 to 5.5
• In multipara size increase by 1 to 2 cm in all diameters

27. CONT.
•Endometrial thickness:
1.premenopausal:
-during menstruation: 2 to 4 mm
-early proliferative phase: 5 to 7 mm
-late proliferative phase: up to 11 mm
-secretory phase: 7 to 16 mm
2.postmenopausal:
-without vaginal bleeding: up to 8 mm
-with vaginal bleeding: < 5 mm

28. SONOGRAPHIC ANATOMY
• Myometrium is normally homogenous structure with
fine parallel linear echoes
• Endometrium:
-menstruation: thin, hyperechoic line and may contain fluid
-proliferative: thickens slightly and develops multilayered
appearance, also known as trilaminar
-secretory: thickens and becomes uniformly hyperechoic

30. ENDOMETRIAL CHANGES THROUGH MENSTRUATION

31. POD FLUID

32. OVARIES
• Lie lateral to uterus in ovarian fossa
• Oval shaped with long axis oriented downward and
forward
• Size:
-nulliparous: 9 ml (maximum)
-reproductive age: 22 ml (maximum)
• Dominant follicle: 20 to 25 mm in diameter at maturity

33. SONOGRAPHIC ANATOMY
• Hypoechoic when
compared with
myometrium
-echoic central area
(corresponding to stroma)
-peripheral area (cortex)

34. OVARY CHANGES DURING MENSTRUATION
DOMINANT CORPUS LUTEUM CORPUS LUTEUM

35. ABDOMINAL AORTA
• Continuation of thoracic aorta beginning at aortic hiatus
in diaphragm and ends at 4th lumbar vertebra
• Divides into common iliac arteries

36. SONOGRAPHIC IMAGE

37. INFERIOR VENA CAVA
• Formed by convergence of
iliac veins
• Right of aorta
• Normal size : < 2.5 cm
(diameter), varies with
respiration

38. SUPERFICIAL SCAN:PYLORIC CANAL
L: <12 mm
T: <3mm

39. APPENDIX
• Normal appendix is worm
like extension of caecum
• Average length: 8 to 10 cm
• Diameter: < 6 mm
• Appearance: inner
hypoechoic band without
folding

40. REFERENCES
• Rumack , Diagnostic Ultrasound , Fifth Edition
• WHO Manual of Diagnostic Ultrasound
• Internet(radiopedia)
• Gray’s anatomy