M2 Flashcards
(blank) is compared to
surrounding tissues
Echogenicity
Homogenous echo texture with ranges in echogenicity
Organ parenchyma
Homogenous, hypoechoic
Muscle
Homogenous, hypoechoic, and
hyperechoic borders
Tissue
Homogenous, hyperechoic
Placenta
Anechoic lumen, hyperechoic walls
Fluid Filled Structures
Fluid filled structures examples
Amniotic Sac
Blood vessels
Brain Ventricles
Ducts
Gallbladder
Ovarian Follicles
Renal Calyces
Umbilical Cord
Urinary Bladder
GI Tract
• Fluid
• Gas
• Food, gas, fluid, feces
Anechoic
Hyperechoic
Complex
Air
Bones
Diaphragm
Fat
Fissures
Ligaments
Echogenic/ Hyperechoic
(white)
Professional and Clinical
Standards
• Courtesy, Respect
• Dress appropriately
• Explain, Instruct, Assist
• Identify, Introduce yourself
• Know Procedures and Protocols
• Never talk about sonographic
findings or give your opinion on the
results
• Only physicians can legally render
a diagnosis
7.5 – 15 MHZ
• For superficial structures
• 1 – 3 cm from the surface
• Thyroid, breast, testicle
2.25 – 3.5 MHZ
• For deeper structures (abdomen/pelvis)
• 12 – 15 cm from the surface
• Liver, Kidneys, Urinary Bladder
• Present images and details of the study
• State exam and reason
• Patient history, correlative data/studies
• Logical sequence
• Discuss technique, related anatomy, abnormal
findings
Case presentation
IMAGE DOCUMENTATION
• Areas of interest
• Date, time, site
• Endocavital studies – witnessed by
another health professional
• Film labeling
• Patient’s name, Sonographer’s
name
Imaging Criteria
Image documentation
Imaging
Transducer selection
DESCRIBING
SONOGRAPHIC FINDINGS
• Abnormal Findings
• Appropriate terminology
• Demonstrate the abnormality on the images
• Technical observation – should not be legally compromising
SAGITTAL, TRANSVERSE, CORONAL
ANTERIOR, POSTERIOR, SUPERIOR,
INFERIOR, LATERAL, MEDIAL
SCANNING PLANES
How to use the Transducer
• – straight up and down
• – superior, inferior, lateral
• – beneath inferior intercostal margin, angled superiorly
• - between ribs
• – oblique scanning planes
Perpendicular
Angled
Subcostal
Intercostal
Twisting
SURFACE LANDMARKS
• Midline - Sternum
Symphysis pubis
Umbilicus
• Lateral - Iliac crest
Inferior costal margin
PATIENT POSITIONS
Prone
Supine
Right/Left Posterior Oblique
Right/Left Lateral Decubitus
Sitting Erect/Semi-erect
Blood supply in PANCREAS
Gastroduodenal artery
Splenic artery
Superior Mesenteric Artery
Venous drainage in PANCREAS
Superior Mesenteric Vein
Splenic Vein
Main pancreatic duct
Wirsung duct
accessory pancreatic duct
Santorini duct
LIVER DIVISIONS
Caudate
Left
Right
CAUDATE lobe is separated from the LEFT lobe by:
ligamentum venosum
LIVER LIGAMENTS
CORONARY LIGAMENT
FALCIFORM LIGAMENT
GASTROHEPATIC LIGAMENT
HEPATODUODENAL LIGAMENT
LIGAMENTUM TERES
LIGAMENTUM VENOSUM
TRIANGULAR LIGAMENT
COUINAUD’S NUMBERING SYSTEM
1 Caudate
2 Left Superior Lateral
3 Left Inferior Lateral
4a Left Superior Medial
4b Left Inferior Medial
5 Right Inferior Anterior
6 Right Inferior Pesterior
7 Right Superior Posterior
8 Right Superior Anterior
LIVER SPACES
MORISON PIUCH
SUBHEPATIC SPACE
SUBPHRENIC SPACE
LEFT lobe is separated from the RIGHT lobe by:
MIDDLE HEPATIC VEIN superiorly & MAIN LOBAR FISSURE inferiorly
Indications for Examination in Liver
AABHPPP
Abdominal pain
Abnormal liver function tests
Biliary disease
Hepatocellular disease
Palpable liver or spleen
Pancreatitis
Postprandial pain
PATHOLOGIES: LIVER
CIRRHOSIS
FATTY LIVER DISEASE
HEPATOMEGALY
PASSIVE HEPATIC CONGESTION
VIRAL HEPATITIS
BENIGN LIVER LESIONS
ABSCESS
BENIGN HEPATIC CYST
CAVERNOUS HEMANGIOMAS
HEPATIC CALCIFICATION
LIVER HEMATOMA
MALIGNANT LIVER LESIONS
HEPATIC METASTASIS
HEPATOCELLULAR CARCINOMA
retroperitoneal organ
pancreas
intraperitoneal organ
liver
medial externsion of head
uncinate process
lies posterior of stomach
tail
separates uncinate process & pancreatic neck
superior mesenteric vein
sonographic apperance
tail: 1 - 2 cm mid gray homogenous
pancreas: isoechoic/ hyperechoic to liver
splenic vein, IVC: anechoic
Indications for Examination in Pancreas AABEPW
Abdominal distention
Anorexia
Biliary disease
Elevated pancreatic enzymes
Pancreatitis
Weight loss
Transabdominal anterior approach
Axial survey
Longitudinal survey
LIVER SURVEY
INTERCOSTAL APPROACH
TRANSABDOMINAL ANTERIOR APPROACH
Pancreas survey
Transabdominal Anterior Approach
PATHOLOGIES OF PANCREAS
ACUTE PANCREATITIS
CHRONIC PANCREATITIS
PANCREATIC ADENOCARCINOMA
PANCREATIC PSEUDOCYST
Indications for Examinations in GB
Jaundice
Nausea
Positice Murphy Sign
Postprandial pain
RUQ pain
PATHOLOGIES OF GB & BILIARY TRACT
BILE SLUDGE
CHOLECYSTITIS
CHOLELITHIASIS
CHOLESTEROLOSIS
GB CANCER
GB POLYPS
PORCELAIN GB
BILIARY TREE PATHOLOGIES
ASCARIASIS
BILIARY OBSTRUCTION
CHOLANGIOCARCINOMA
CHOLEDOCHAL CYST
CHOLEDOCHOLITHIASIS
starry sky apperance
acute hepatitis
spleen sonographic appearance
homogenous with medium level echoes
spleen sonographic appearance
spleen is isoechoic/ hypoechoic compared to liver
spleen sonographic appearance
spleen is hyperechoic relatively to the left kidney
pancreas sonographic appearance
pancreas is hyperechoic to liver