This document provides an overview of the basic sonographic anatomy of major organs. It discusses the interactions of ultrasound waves with different tissues and scanning techniques for organs like the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, and bladder. Key points include how ultrasound is used to visualize the internal structure of organs, identify important landmarks, and evaluate for any abnormalities. Proper patient preparation and positioning techniques are also covered to optimize image quality.
Ultrasound renal stone differential diagnosis .AHMED ESAWY
renal sinus ultrasound
stone location in calyx
(not in medulla,not in cortex)
echogenic foci
acoustic shadowing
twinkle artifact on colour Doppler
color comet tail artifact
Staghorn calculi
Ultrasound beam-stone angle
Difference between kidney gravel & stone
RENAL ECHOCONCRETION
Vascular Reflectors (Normal or calcified renal vessels are the most
notable and common causes of intrarenal
bright echo reflectors)
Segmental Arteries
Arcuate Arteries
Sinus Vessels
renal vein thrombosis calcification
Calcifications of the branches of the renal artery
Nonvascular Reflectors: Prominent Papillae
Reflectors Within the Renal Parenchyma
Milk of Calcium Cysts
Renal Cortical Calcification
Junctional Parenchymal Line
Angiomyolipomas
Foreign Bodies
Bright echoes within the Renal Parenchyma
medullary nephrocalcinosis
focal pyelonephritis.
Echogenic tips of the renal pyramids apex
Transient pyramidal echogenicity
echogenic neonate renal pyramids (Tamm-Horsfall protein)
fungal balls
blood clots
Renal calcification in infants with Furosemid therapy
Basic principles of ultrasound.
Terms used in ultrasound.
Advantages of ultrasound.
Definition of acute abdomen.
Differential Diagnosis.
Abdominal ultrasound technique.
USG findings in most common pathologies.
Conclusion.
Full story fatty liver imaging Dr Ahmed EsawyAHMED ESAWY
Full story fatty liver imaging dr ahmed esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
Diagnosis at US
Diagnosis at CT
Diagnosis at MR Imaging
Elastography
Contrast enhanced ultrasound
Liver Pathology (Diffuse Diseases).
Criteria for fatty liver on USG
Grading of fatty liver
Fatty fibrotic pattern
Diagnosis at CT
Diagnosis at MR Imaging
Potential pitfalls in Opposed-phase T1 include
Accuracy for Detection and Grading of Fat Deposition
Patterns of Fat Deposition
Diffuse Deposition.
Focal Deposition and Focal Sparing.
Multifocal Deposition.
Perivascular Deposition.
Subcapsular Deposition.
Focal Deposition and Focal Sparing
Fatty Pseudolesions of the Liver: Postoperative Changes
Differential Diagnosis
Primary Lesions and Hypervascular Metastases.
Hypovascular Metastases and Lymphoma.
Perfusion Anormalies.
Periportal Abnormalities
Pitfalls
Fat-containing Primary Tumors.
Low-Attenuation Lesions.
Focal Sparing that Mimics an Enhanced Tumor.
Ultrasound renal stone differential diagnosis .AHMED ESAWY
renal sinus ultrasound
stone location in calyx
(not in medulla,not in cortex)
echogenic foci
acoustic shadowing
twinkle artifact on colour Doppler
color comet tail artifact
Staghorn calculi
Ultrasound beam-stone angle
Difference between kidney gravel & stone
RENAL ECHOCONCRETION
Vascular Reflectors (Normal or calcified renal vessels are the most
notable and common causes of intrarenal
bright echo reflectors)
Segmental Arteries
Arcuate Arteries
Sinus Vessels
renal vein thrombosis calcification
Calcifications of the branches of the renal artery
Nonvascular Reflectors: Prominent Papillae
Reflectors Within the Renal Parenchyma
Milk of Calcium Cysts
Renal Cortical Calcification
Junctional Parenchymal Line
Angiomyolipomas
Foreign Bodies
Bright echoes within the Renal Parenchyma
medullary nephrocalcinosis
focal pyelonephritis.
Echogenic tips of the renal pyramids apex
Transient pyramidal echogenicity
echogenic neonate renal pyramids (Tamm-Horsfall protein)
fungal balls
blood clots
Renal calcification in infants with Furosemid therapy
Basic principles of ultrasound.
Terms used in ultrasound.
Advantages of ultrasound.
Definition of acute abdomen.
Differential Diagnosis.
Abdominal ultrasound technique.
USG findings in most common pathologies.
Conclusion.
Full story fatty liver imaging Dr Ahmed EsawyAHMED ESAWY
Full story fatty liver imaging dr ahmed esawy
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
Diagnosis at US
Diagnosis at CT
Diagnosis at MR Imaging
Elastography
Contrast enhanced ultrasound
Liver Pathology (Diffuse Diseases).
Criteria for fatty liver on USG
Grading of fatty liver
Fatty fibrotic pattern
Diagnosis at CT
Diagnosis at MR Imaging
Potential pitfalls in Opposed-phase T1 include
Accuracy for Detection and Grading of Fat Deposition
Patterns of Fat Deposition
Diffuse Deposition.
Focal Deposition and Focal Sparing.
Multifocal Deposition.
Perivascular Deposition.
Subcapsular Deposition.
Focal Deposition and Focal Sparing
Fatty Pseudolesions of the Liver: Postoperative Changes
Differential Diagnosis
Primary Lesions and Hypervascular Metastases.
Hypovascular Metastases and Lymphoma.
Perfusion Anormalies.
Periportal Abnormalities
Pitfalls
Fat-containing Primary Tumors.
Low-Attenuation Lesions.
Focal Sparing that Mimics an Enhanced Tumor.
Introducing Diagnostic Ultrasound in General Practiceupstatevet
Chris Ryan, DVM, DACVR
This lecture will begin by reviewing the basic operation of ultrasound equipment with a focus on hardware and software features common to almost all machines. The various settings and controls will be reviewed, along with the effects that these have on overall image quality, and how to utilize these settings to optimize image quality. A roadmap will then be developed for applying ultrasound in everyday general practice, beginning with the basics of evaluation for abdominal or pleural cavity fluid, and proceeding to perform a complete basic abdominal ultrasound exam. Normal sonographic anatomy and measurements will be reviewed, along with a recommended acquisition protocol for submission to teleradiology services.
Sonological features of Pancreatitis.pptxvinodkrish2
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Acute pancreatitis
Last revised by Rohit Sharma on 27 Sep 2023
Citation, DOI, disclosures and article data
Acute pancreatitis (plural: pancreatitides) is an acute inflammation of the pancreas and potentially life-threatening.
On this page:
Article:
Terminology
Epidemiology
Diagnosis
Clinical presentation
Pathology
Radiographic features
Treatment and prognosis
Differential diagnosis
See also
Related articles
References
Images:
Cases and figures
Terminology
Two subtypes of acute pancreatitis are described in the Revised Atlanta Classification 1:
interstitial edematous pancreatitis
the vast majority (90-95%)
most often referred to simply as "acute pancreatitis" or "uncomplicated pancreatitis"
necrotizing pancreatitis
necrosis develops within the pancreas and/or peripancreatic tissue
Epidemiology
The demographics of patients affected by acute pancreatitis reflect the underlying cause, of which there are many (see Pathology below).
Diagnosis
The diagnosis of acute pancreatitis is usually based on clinical criteria or a combination of clinical and radiographic features 1.
Diagnostic criteria
Two of the following three criteria are required for the diagnosis 1:
acute onset of persistent, severe epigastric pain (i.e. pain consistent with acute pancreatitis)
lipase/amylase elevation >3 times the upper limit of normal
characteristic imaging features on contrast-enhanced CT, MRI, or ultrasound
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Clinical presentation
Classical clinical features include 3:
acute onset of severe central epigastric pain (over 30-60 min)
poorly localized tenderness and pain
exacerbated by supine positioning
radiates through to the back in 50% of patients
Elevation of serum amylase and lipase are 90-95% specific for the diagnosis 3.
A normal amylase level (normoamylasaemia) in acute pancreatitis is well-recognized, especially when it occurs on the ground of chronic pancreatitis. A normal lipase level has also been reported (<10 case reports) but is extremely rare 16.
(Rare) signs of hemorrhage on the physical exam include:
Cullen sign: periumbilical bruising
Grey-Turner sign: flank bruising
Pathology
There continues to be debate over the precipitating factor leading to acute pancreatitis, with duct occlusion being an important factor, but neither necessary nor sufficient.
Mechanism notwithstanding, activation of pancreatic enzymes within the pancreas rather than the bowel leads to inflammation of the pancreatic tissue, disruption of small pancreatic ducts, and leakage of pancreatic secretions. Because the pancreas lacks a capsule, the pancreatic juices have ready access to surrounding tissues. Pancreatic enzymes digest fascial layers, spreading the inflammatory process to multiple anatomic compartments.
Etiology
gallstone passage/impaction: most common cause of acute pancreatitis (up to 15% develo
The abdominal examination consists of four basic components: inspection, palpation, percussion, and auscultation. It is important to begin with the general examination of the abdomen with the patient in a completely supine position. The presence of any of the following signs may indicate specific disorders.
Excretionurography
Also known as intravenous urography (IVU).
Most frequently employed radiologic investigation of renal rainage.
The contrast material is administered intravenously.
Best method for adults unless use of other methods is specified and is used in examinations of upper urinary tracts of infants and children.
Brief description of genitourinary system-related disorders with their nursing management. This presentation involves glomerulonephritis, nephrotic syndrome, acute renal failure, and renal calculi.
Essential Drugs Dosage and Formulations (Medical Booklet Series by Dr. Aryan ...Dr. Aryan (Anish Dhakal)
This is the 22nd part of medical booklet series created by Dr. Aryan in order to familiarize doctors and medical students about the basic doses of drugs. Many students remember the mechanism of actions and other details of drug very well and regard doses as unnecessary. While you prescribe, this becomes one of the most important aspect. This study material is focused to resolve such issues.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Delirium, also referred to as "acute confusional state" or "acute brain syndrome," is a condition of severe confusion and rapid changes in brain function.
Skin warts are benign tumours caused by infection of keratinocytes with HPV, visible as well‐defined hyperkeratotic protrusions. We will explore the detailed types, presentation, and treatment modalities of most common warts.
Journal Club: Prophylactic Thyroidectomy in Multiple Endocrine Neoplasia 2 Dr. Aryan (Anish Dhakal)
The study aims to analyze the long-term results of a large cohort of MEN2 patients with the C634Y mutation who had undergone prophylactic thyroidectomy in a tertiary referral hospital, and to analyze the results in terms of age and calcitonin levels.
Surgery Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Part...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Pediatrics Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan P...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Medicine Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Par...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Gynaecology and Obstetrics Review Booklet by Dr. Aryan (Medical Booklet Serie...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Radiology Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Pa...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Ophthalmology Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Arya...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Forensic Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Par...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
ENT Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Part 12)Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Dentistry Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan Pa...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Dermatology Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan ...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Anaesthesia Review Booklet by Dr. Aryan (Medical Booklet Series by Dr. Aryan ...Dr. Aryan (Anish Dhakal)
This is a part of free booklet series designed by Dr. Aryan for rapid review of basic concepts of medical science. I grant you right to share the booklet for fair use (teaching, scholarship, education and research) anywhere in the world exclusively for non-monetary purposes.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
1. Basic Sonographic Anatomy of
Major Organs
Presented by:
Anish Dhakal (Aryan)
MBBS, Patan Academy of Health Sciences
2.
3.
4. What hapens to ultrasound wave?
1. Transmission (Small difference in acoustic impedance = greater
transmission)
2. Reflection : source for ultrasound image
3. Scattering: mostly occurs with RBCs
4. Attenuation: resulting in heat production
5. Refraction: can result in double image artifacts due to difference in
acoustic impedence between body tissues
5. • Fluid: most acoustical energy is transmitted
• Gas or bone: most energy reflected back, not enough energy to
define deeper structures
• Hyperechoic
• Hypoechoic/Sonolucent/Anechoic
• Longitudinal & Transverse Plane
• Patient’s head: your left, Patient’s feet: your right
• Anterior is up & Posterior is down
6. Preparation
• Patient preparation:
• Patient should be NPO for at least 8 hours unless there is
possibilities of dehydration
• In that case water should be given
• As the examination proceeds and there is no clinical
contraindication, water should be given especially when
scanning pancreas, lower abdomen and pelvis
7. Preparation
• Patient position:
• Supine
• Pillow under head
• If much tenderness one pillow should be under the knee
• Choice of transducer:
• For adult 3.5 MHz
• For children and thin adults 5 MHz
8. Scanning technique
• Apply coupling agent
• Start by placing the probe centrally at the top of the abdomen (at
xiphoid angle)
• Slowly move the transducer from the midline across the abdomen to
the right, stopping to check the image approximately every 1 cm.
• Repeat at different level
• Examine the left side in the same way when right side is completed.
• Ask the patient to take deep breath and hold it.
9.
10. Liver scan
• Normal liver:
• Liver parenchyma appears homogenous, interrupted by portal vein
and its branches
• Portal vein and its branches appears tubular structure with
reflecting walls (bright)
• The thinner hepatic veins are non-reflective
• It is possible to follow hepatic veins to their confluence with the
inferior venacava
• Hepatic veins can be made dilated by Valsalva maneuver
14. • Right and left lobes of lever can be recognized by identifying
the falciform ligament fissure
• Caudate lobe is recognized by identifying the inferior
venacava.
• Caudate lobe is limited posteriorly by inferior venacava and
separate antero-superiorly from the left lobe by a highly
reflective line.
• Caudate lobe must be identified because it may be mistaken
for a mass.
15.
16. • The normal echogenicity of liver parenchyma is mid way between
pancreas (more echogenic) and spleen (less echogenic)
17. Gall bladder and biliary tree scanning
technique
• Start with longitudinal scan, then transverse scan and
intercostal scan if necessary
• Then turn the patient on the left and make oblique scans at
different angles
• If there is excess bowel gas, examine the patient standing
erect.
• Hand knee position can be used to demonstrate gallstone
more clearly allows the stones to move more anteriorly.
18.
19.
20. Normal anatomy of gall bladder
• On longitudinal scan, it appears echo free, pear shaped structure.
• It is very variable in shape, size, position but normal gall bladder is
seldom more than 4 cm wide.
Longitudinal scan
21. • The thickness of gall bladder wall can be measured by transverse scan
• In a fasting patient, it is 3 mm
• Distended gall bladder has 1 mm thickness
Transverse section: Full gallbladder (wall thickness 1mm)
22. Longitudinal (upper) and transverse (lower) scans of a contracted gallbladder (wall
thickness less than 3 mm)
23.
24. Non-visualization of gallbladder
• The patient has not been fasting: re-examine after an
interval of at least 6 hours without food and drink
• The gall bladder lies in an unusual positions:
• Scan low down in the right abdomen, even as low as the
pelvis
• Scan to the left of the midline and in the patient in the
oblique position with the right side down
• Scan high under the costal margin
25. Non-visualization of gallbladder
• The gallbladder is congenitally hypoplastic or absent
• It is shrunken and full of stones with associated acoustic
shadowing
• It has been removed surgically: examine the abdomen for
scars and ask the relatives
• The examiner is not properly trained or experienced: ask the
colleague to examine the patient
26. Biliary ducts
• It is not always easy to identify the normal main left and
right hepatic bilary ducts, but when visible they are within
the liver and appear as thin walled tubular structure
• Common hepatic duct can be recognized just anterior and
lateral to the crossing portal vein.
• Its cross-section at this point should not be more than 5 mm
• The diameter of common bile duct is variable but should not
exceed 9 mm near its entrant into pancreas
27. Oblique scan: normal common bile duct
Transverse scan: normal common bile duct at porta hepatis
30. Pancreas scan
• Pancreas can be very difficult to find out especially the tail
• Start with transverse scan across the abdomen moving downwards towards
the feet until the splenic vein is seen.
• Splenic vein is seen as a linear, tubular structure with the medial end
broadened.
• This is where it is joined by superior mesenteric vein at the level of the
neck of the pancreas
• The superior mesenteric artery will be seen in cross section just below the
vein.
• By angling and rocking the transducer, the head and tail of the pancreas
can be seen
34. • Continue transverse scan downward to visualize the head of the
pancreas and uncinated process between the inferior venacava and
portal vein
Transverse scan: head of the normal pancreas scanned
through the left lobe of the liver
35. Transverse scan: tail of the normal pancreas
Transverse scan: Normal pancreatic duct
36. Longitudinal scanning of the pancreas
• Start just to the right of the midline and identify the tubular pattern
of the inferior vena cava with the head of the pancreas anteriorly,
below the liver
• The vena cava should not be compressed or flattened by normal
pancreas.
Longitudinal scan:
Inferior vena cava and
head of the pancreas
37. • Continue longitudinal scan moving to the left
• Identify the aorta and superior mesenteric artery
• This will help identifying body of pancreas
Longitudinal scan: The aorta and body of pancreas
38. Normal pancreas
• Pancreas has about the same echogenicity as the adjacent
liver and should appear homogenous.
• However, the pancreas echogenicity increases with age
• The outline of normal pancreas is smooth.
39. Essential landmarks while scanning pancreas
• Aorta
• Inferior vena cava
• Superior mesenteric artery
• Splenic vein
• Superior mesenteric vein
• Wall of the stomach
• Common bile duct
Note: The most essential land marks are superior mesenteric artery and
splenic vein
40. • The average diameter of head of the pancreas is 2.8 cm
• The average diameter of medial part of the body of pancreas
is less than 2 cm
• The average diameter of tail of the pancreas is 2 cm
• The diameter of pancreatic duct should not exceed 2 mm. it
is normally smooth and wall and lumen can be identified
• The accessory pancreatic duct is seldom visualized.
42. • Scan from below the costal margin, aligning the beam towards the
diaphragm, then in the 9th intercostal space downwards.
• Repeat through all intercostal spaces, first with the patient supine and
then with the patient lying obliquely (30 degree) on right side.
43. • Also perform longitudinal scans from anterior to posterior axillary
lines and transverse upper abdominal scans.
• Scan the liver also, particularly when spleen is enlarged
44. Normal spleen
It is important to identify:
• Left hemi-diaphragm
• Splenic hilus
• Splenic vein and relationship to pancreas
• Left kidney and renal-splenic relationship
• Left edge of liver
• Pancreas
45. • When spleen is normal size , it is difficult to image completely
• The splenic hilus is the reference point to ensure correct identification
of the spleen
• Identify the spleen as the entry point of splenic vessels
Oblique scan: normal spleen and left kidney
46. Echo pattern of spleen
• The spleen should show a uniform pattern of homogenous
echogenicity
• It is slightly less echogenic than lever
48. • Full bladder is required
• Scanning is always done in
deep suspended
inspiration
• Start with the longitudinal
scan over the right upper
abdomen and then follow
with the transverse scan to
visualize the right kidney in
the coronal view
Kidney and ureter scanning
49. • If the left kidney is not visualized generally with bowel gas, try to
visualize in the right decubitus position
• Bowel gas can also be displaced by drinking 3-4 glasses of water
Attenuation: absorption and scattering of ultrasound resulting in producing the heat which is one of the bad effects of ultrasound.( so, Ultrasound probe should not be kept in same place for a long time. )
Ultrasound is said to be safe if - the body temperature rises only <= 1 degree
- the power is 1 watt/square cm.
But ultrsound has more power that that value but, till now there has been not such known deleterious effect by ultrasound.
Refraction: It is the phenomenon of bending of waves when the sound wave passes from one medium to another medium with diffrenet acoustic impedance.
Acoustic impedance (z)= density d) * speed of sound wave (c)