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Abdominal Wall Flashcards

1
Q

What are the indications for an abdomen wall US?

A
  • Palpable mass (wall vs abdomen)
  • Surgical wound assessment
  • Trauma
  • Findings on other imaging modalities
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2
Q

Describe the scanning technique

A
  • High frequency linear transducer

- Minimal pressure used

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3
Q

Is pt prep required for scanning the abdominal wall?

A

No

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4
Q

What are the 3 abdominal wall layers?

A
  1. Epidermis
  2. Subcutaneous tissue
  3. Muscle
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5
Q

How thick is the epidermis?

A

1-4mm

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6
Q

What is the echogenicity of the epidermis?

A

Highly reflective layer, appears echogenic

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7
Q

What tissue is the subcutaneous layer made of?

A

Fat

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8
Q

How thick is the subcutaneous layer?

A

Variable

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9
Q

What is the echogenicity of the subcutaneous layer?

A

Variable- typically less echogenic than muscle

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10
Q

What factors influence echogenicity of fat?

A

Water content determines echogenisty of fat:
greater the water content- greater the echogenisty because there are multiple interfaces- all these interfaces are hyperechoic

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11
Q

Describe the rectus abdominis

A

Paired, midline anterior to abdominal wall

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12
Q

Where is the origin of the rectus abdominis?

A

PS and pubic crest and inserts into the xiphoid process and costal cartilage

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13
Q

What separates the rectus abdominis midline?

A

Linea alba

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14
Q

What encloses the RA muscle?

A

Rectus sheath

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15
Q

What forms the RA muscle?

A

Aponeuroses of the internal, external and transverse abdominus

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16
Q

What is the aponeuroses?

A

Flat sheets of strong, fibrous connective tissue that serve as tendons to attach muscle to fixed points

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17
Q

How many tendinous insertions attach the rectus shealth

A

3

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18
Q

What pathology can be seen by the 3 tendinous insertion points of the rectus sheath?

A

Localized hematomas

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19
Q

What is the linea alba?

A

Fibrous band that extends from the xiphoid to the PS

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20
Q

What forms the linea alba?

A

Aponeuroses of the 3 lateral abdominal muscles

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21
Q

Where is the linea alba the widest?

A

Above umbilicus

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22
Q

What common artifact does the linea alba cause?

A

Refractive duplication artifact

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23
Q

What is the sonographic appearance of the linea alba?

A

Echogenic

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24
Q

What is the arcuate line?

A

Point b/w umbilicus and symphysis where the posterior portion of the rectus sheath passes in front the rectus muscle

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25
Where does the external oblique originate?
Outer surface of the lower 8 ribs
26
Where does the external oblique muscle insert into?
Xiphoid, linea alba, pubic bone and anterior iliac crest
27
What is the most outer layer of the abdominal muscle?
External oblique
28
Where does the internal oblique muscle originate?
Lumbar fascia, anterior iliac crest and inguinal ligament
29
Where does the internal oblique muscle insert?
Into the lower 3 ribs, xiphoid, linea alba and SP
30
How does the internal oblique run in comparison to the external oblique?
Runs 90 deg to the external oblique
31
Where does the transversus abdominis originate?
Lower 6 ribs, lumbar fascia, iliac crest and inguinal ligament
32
Where does the transversus abdominis insert?
Xiphoid process, linea alba and PS
33
What is the sonographic appearance of the muscle?
Hypoechoic to sonolucent Striated appearance Specular reflectors
34
What are the 3 posterior wall muscles?
1. Psoas Major 2. Quadratus Lumborum 3. Iliacus
35
What is the shape of the psoas muscle?
Fan shaped
36
Where does the psoas muscle originate?
Sides of the vertebral column
37
Where does the psoas muscle insert?
Lesser trochanters of femurs
38
How does the psoas muscle appear sonographically?
Hypoechoic and lateral to the spine
39
Where is the QL positioned in comparison to the psoas muscle?
Posterolateral
40
Where does the QL originate?
Iliac crest
41
Where does the QL insert?
12th rib and upper 4th lumbar vertebrae
42
Where is the QL positioned compared to the kidney?
Posterior
43
Where does the Iliacus originate?
Iliac fossa, sacrum and SI jts
44
Where does the iliacus insert?
Psoas major and lesser trochanters
45
What is the inguinal canal?
Obliquely oriented tunnel Slit like structure
46
How does the inguinal canal run?
Inferior and medial
47
What is the deep inguinal ring?
Opening at the superior end of the canal - defect in the transversalis fascia
48
Where is the deep inguinal canal located?
Midway b/w anterior superior iliac spine and PS
49
What is the superficial inguinal ring?
Opening at the inferior end of the canal
50
Where does the superficial inguinal ring go through?
External oblique aponeurosis
51
What structures does the inguinal canal contain?
Spermatic cord and round ligament of uterus
52
What forms the anterior wall of the inguinal canal?
Aponeurosis of the external oblique muscle
53
What forms the posterior wall of the inguinal canal?
Transversalis fascia
54
What is the diaphragm made of?
Muscle and tendon
55
Where does the diaphragm originate?
At the periphery of the thoracic cage with 3 groups of muscle fibres
56
What are the 3 groups of muscle fibres of the thoracic cage?
1. Lumbar spine (crura)- right (border and longer) and left Join in midline to form the arcuate line 2. Lower sternum 3. Lower 6 ribs
57
Where do the 3 groups of muscle fibres converge radially and insert into?
Central tendon
58
How does the crura appear sonographically?
Thin- hypoechoic band Superior to CA- ant to aorta At CA- lat to aorta Posterior to IVC
59
What are the 2 scanning approaches used in US to assess the pleural space?
Abdominal approach (subcostal) and intercostal
60
What are the 2 windows used when scanning the inferior pleura spaces?
Liver and spleen
61
What is the normal thickness of the diaphragm?
5mm or less
62
What is a mirror image artifact an indication of when identified in the plerual space?
Evidence of absense of pleural fluid
63
What is the distance of the pleural space from the rib interface when scanning intercostally?
Pleural space within 1cm from rib interface
64
What is the difference between the sonographic appearances of the visceral pleura compared to the parietal pleura?
Visceral- bright linear interface, moves with respiration "gliding sign" Parietal- weak echogenic line or obscured, hypogenic separation of visceral and parietal pleura
65
What is the meaning of the gliding sign?
When the visceral layer moves with respiration

Abdomin And Superficial Structures (12 decks)

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