This document provides an overview of the techniques and findings for abdominal and pelvic ultrasound examination. It outlines a systematic approach to scanning the major abdominal organs and structures, including the aorta, inferior vena cava, liver, gallbladder, pancreas, spleen, kidneys, and bladder. For each area, normal anatomy and measurements are defined, and common pathological findings are described with examples of ultrasound appearances. The goal is to perform a comprehensive exam in a timely manner while avoiding misses or errors.

1. Abdominopelvic ultrasound
The essentials
Dr/Ahmed Bahnassy
consultant Radiologist
MBCHB-MSc-FRCR(UK)

2. aim of the lecture
• Build a systematic and
rationale approach to routine
abdominopelvic ultrasound
examination,within reasonable
time frame,and without major
missings or avoidable errors.

4. Scanning
technique

5. 1.Abdominal aorta

7. The normal aorta

8. Aortic displacement

9. Aortic dilatation

10. Abdominal aortic aneurysm

11. Aortic dissection

12. Aortic narrowing

13. Aortitis

14. 2-The inferior vena cava

15. The normal IVC

16. Dilatation

17. Displacement

18. IVC masses

19. 3.The liver

20. Scanning technique

21. Couinaud classification
• Used to describe functional liver anatomy.
• It is preferred over morphological liver
anatomy since it allows the division of the
liver into 8 independent functional units.

22. • The separation of the units is based on the
fact that each has its own vascular inflow,
outflow and biliary drainage.

24. • The classification system uses the vascular supply in the
liver to separate the functional units (numbered I to VIII):
– right hepatic vein divides the right lobe into anterior and
posterior segments
– middle hepatic vein divides the liver into right and left lobes:
this plane runs from the inferior vena cava to the gallbladder
fossa
– left hepatic vein divides the left lobe into a medial and lateral
part
– portal vein divides the liver into upper and lower segments: the
left and right portal veins branch superiorly and inferiorly to
project into the central of each segment

27. Anatomic liver segments
caudate lobe Segment I
Lateral segment left
lobe superior
Segment II
Lateral segment left
lobe inferior
Segment
III
Medial segment left
lobe
Segment
IV
Anterior segment right
lobe inferior
Segment V
Posterior segment right
lobe inferior
Segment
VI
Posterior segment right
lobe superior
Segment
VII
Anterior segment right
lobe superior
Segment
VIII

29. – unit I is the caudate lobe and is situated
posteriorly.
• The remainder of the units (II to VIII) are
numbered in a clockwise fashion.
– units II and III lie lateral to the falciform
ligament with II superior to the portal venous
supply and III inferior.
– unit IV lies medial to the falciform ligament
and is subdivided into IVa (superior) and IVb
(inferior).

30. • Units V to VIII make up the right hemiliver.
– unit V is the most medial and inferior.
– unit VI is located more posteriorly, with
– unit VII above it.
– unit VIII sits above unit V in the superio-
medial position.

32. The enlarged liver-homogeneous

33. Look upwards

34. Look on each side

35. Normal hepatic veins doppler

36. tetrainflectional wave
Diagram illustrates normal hepatic venous flow direction and waveform. The direction of normal flow is
predominantly antegrade, which corresponds to a waveform that is mostly below the baseline at spectral
Doppler US. The term triphasic, which refers to the a, S, and D inflection points, is commonly used to
describe the shape of this waveform; according to D.A.M., however, this term is a misnomer, and the
term tetrainflectional is more accurate, since it includes the v

37. Tricuspid regurge

38. Spectral Doppler image clearly shows increased pulsatility. Careful observation shows a pattern that is specific to
right-sided CHF without tricuspid regurgitation. The a wave is very tall, and the normal relationship between the S and
D waves is maintained (S [systole] is deeper than D [diastole]).
Right-sided CHF without tricuspid regurgitation.

39. cirrhosis
Decreased hepatic venous phasicity. Diagrams illustrate varying
degrees of severity of decreased phasicity in the hepatic vein.
Farrant and Meire first described a subjective scale for
quantifying abnormally decreased phasicity in the hepatic veins,
a finding that is most commonly seen in cirrhosis.

40. Periportal brightness

41. enlarged liver with masses

42. metastasis

43. Lymphoma

44. The small liver

45. Focal lesions

46. Liver cysts

47. Haemorrhagic cyst

48. Hydatid cysts

49. Infected cyst

50. Calcified cysts

51. Multiple liver masses

52. Single solid liver mass

53. Liver
abscesses
patterns

54. Liver abscess

55. Subphrenic abscess

56. Looking for pleural involvement

57. Liver trauma

58. 4-gall bladder and biliary tract

59. Normal

60. full/contracted

61. The normal CBD

62. Non visualized gall bladder

63. Distended gall bladder

64. Gall stones

67. Mobile echoes

68. Non mobile echoes

69. Thick gall bladder wall-diffuse

70. Wall abnormality

71. Focal thickening

72. GB cancer

73. Small GB

74. Jaundiced patient

75. Dilated ducts

76. Cholangiocarcinoma

77. GB in jaundice

78. Mildly dilated ducts

79. Clonorhiasis

80. 5-The pancreas

81. Normal pancreas

82. Decubitus

83. erect after water

84. Normal pancreatic size

85. Small pancreas

86. Diffuse large pancreas

87. Focal enlarged non cystic

88. Focal cystic masses

89. calcifications

90. Pancreatic duct dilatation

91. 6-The spleen

92. Normal spleen

93. Normal scan

94. Splenomegaly

95. Splenic cysts

96. splenic abscess

97. splenic vein evaluation

98. splenic masses

99. Subphrenic abscess

100. Splenic trauma

101. Pitfalls

102. 7-peritoneal cavity and GIT

103. The esophagus

104. The stomach

105. The bowel

106. Ascitis

107. Bowel masses

108. abdominal masses

109. Appendicitis

110. Intussusception

111. 8-Urinary tract

112. probe orientation

113. Normal kidney

115. The adrenal

116. Renal
differential

117. Absent kidney

118. Large kidney-uni or bilateral

119. unilateral

120. focal lesions

121. Surgical cysts

122. solid mass

123. Abscess versus mass

124. Small kidney

125. Renal calculi

126. ureteric stone

127. Renal trauma

128. Adrenal mass

129. 9-The urinary bladder

130. ureteric jet

131. Generalized thickening

132. Localized thickening

133. Density within

134. Overdistended bladder

135. Small bladder