The Abdominal Mass

Question 1

What are some indications for ultrasound examination of the abdominal walls? 4

Answer 1

1. Palpable mass (wall vs abdominal cavity)
2. Surgical wound assessment
3. Trauma
4. Findings on other imaging modalities

Question 2

What kind of transducers do we use for abdominal scans?

Answer 2

High frequency linear transducer

Question 3

What is the amount of pressure we need to use for abdomen wall scans?

Answer 3

Minimal pressure - a stand off pad may be needed

Question 4

What is the patient prep for abdomen wall assessments?

Answer 4

No patient prep needed

Question 5

What is the abdominal wall layers? 3

Answer 5

1. Epidermis
2. Subcutaneous tissue
3. Muscle

Question 6

How thick is the epidermis?

Answer 6

1-4 mm thick

Question 7

What is the sonographic appearance of the epidermis? 2

Answer 7

1. Highly reflective
2. Appears echogenic

Question 8

What is the subcutaneous layer consist of and how thick is it? And what does it look like sonographically? 3

Answer 8

1. Consists of fat
2. Variable thickness and echogenicity
3. Typically less echogenic than muscle

Question 9

The echogenicity of fat is influenced by what?

Answer 9

Water content

Question 10

What does the anterior and lateral muscle walls consist of? 4

Answer 10

1. Rectus abdominis
2. External oblique
3. Internal oblique
4. Transversus Abdominis

Question 11

What are the Posterior wall muscles layers? 2

Answer 11

1. Psoas major
2. Quadratus lumborum

Question 12

What is the Rectus abdominis? Where is it located?

Answer 12

1. Paired midline anterior muscles
2. Extends from symphysis pubis and Punic crest to the diploid process

Question 13

What is the rectus abdominis separated by?

Answer 13

Linea alba midline

Question 14

What is the rectus abdominis enclosed by?

Answer 14

Rectus sheath

Question 15

What is the rectus abdominis formed by?

Answer 15

By the aponeuroses of the internal, external and transverse abdominis

Question 16

The rectus abdominis contains three tendinous insertions between what?

Answer 16

Xiphoid and just inferior to the umbilicus

Question 17

What does the rectus abdominis attach to?

Answer 17

Rectus sheath anteriorly

Question 18

What does the rectus abdominis do?

Answer 18

Localize hematomas

Question 19

What is the linea alba? Where does it extend from? What does it fuse with? 3

Answer 19

1. A fibrous band
2. Extends from xiphoid to the symphysis
3. Fuses with aponeuroses of the three anterolateral wall muscles

Question 20

What is the linea alba wider then?

Answer 20

The umbilicus

Question 21

What is the sonographic appearance of the linea alba?

Answer 21

Echogenic

Question 22

What is the arcuate line?

Answer 22

A point between the umbilicus and symphysis where the posterior portion of rectus sheath passes in front of the rectus muscle

Question 23

What is the external oblique? Where does it originate? How does it run?

Answer 23

1. Outer layer
2. Originates from outer surface of the lower 8 ribs
3. Runs diagonally

Question 24

What does the internal oblique lie? 2

Answer 24

1. Deep to the external oblique
2. Runs diagonally 90 degrees to external oblique

Question 25

What is the transversus abdominis? Where does it lie? And how does it run?

Answer 25

1. Innermost layer 2. Lies deep to internal oblique 3. Runs horizontally

Question 26

What is the sonographic appearance of muscles? 3

Answer 26

1. Hyperechoic to sonolucent 2. Specular reflectors 3. Striated appearance

Question 27

What is the psoas muscles? Where does it originate? And where does it insert? 3

Answer 27

1. Fan shaped muscle 2. Originates in the sides of the vertebral column 3. Inserts into the lesser trochanter of femur

Question 28

What is the u/s appearance of the psoas muscle?

Answer 28

Hyperechoic/ lateral to vertebra

Question 29

What is the Quadratus lumborum? Where does it originate? Where doe sit insert?

Answer 29

1. Flat muscle which is posterolateral to psoas 2. Originates in the iliac crest 3. Inserts directly into the 12th rib, upper 4 lumbar vertebrae

Question 30

What organ is the Quadratus lumborum posterior to?

Answer 30

Kidneys

Question 31

What is the origin of the illacus? Where does it insert? 2

Answer 31

1. Originates at the iliac fossa, sacrum and SI joints 2. Inserts into the psoas major and lesser trochanters

Question 32

What is the deep ring of the inguinal canal? Where is it located? 3

Answer 32

1. Opening at superior end 2. Located midway between ASIS and symphysis 3. Anterior to femoral vessels

Question 33

What is the deep ring defect in?

Answer 33

Transversalis fascia

Question 34

What is the superficial ring? Where does it travel though?

Answer 34

1. Opening at inferior end 2. Travels through external oblique aponeurosis

Question 35

What does the inguinal canal contain?

Answer 35

The spermatic cord in males and the round ligaments in females

Question 36

What is the diaphragm? What does it separate?

Answer 36

1. Dome shaped musculotendinous sheets 2. Separates the thoracic from the abdominal cavity

Question 37

What is the importance of the diaphragm?

Answer 37

It is a major active muscle of respiration

Question 38

What is the origin of the diaphragm?

Answer 38

Periphery of thoracic cage

Question 39

What are the three groups of muscle fibres that forms the diaphragm?

Answer 39

1. Lumbar spine 2. Lower sternum 3. Lower 6 ribs

Question 40

What does the lumbar spine (Curran) consist of in the diaphragm? Where does it join to form? 3

Answer 40

1. 2 Curran (singular -crus) 2. Right (broader and longer) and left 3. Join in middle to form arcuate ligaments

Question 41

What does the diaphragm insert into?

Answer 41

Central tendon *the three groups of muscle fibres converge radially and insert into a central tendon*

Question 42

What is the Crura? Where is it located? (Aorta and at the level of the celiac axis, what does the aorta, and IVC look like?) 4

Answer 42

1. Thin hypoechoic band 2. Superior to celiac axis- anterior to Ao 3. At celiac axis - lateral to aorta 4. Posterior to IVC

Question 43

What are two scanning approaches to scan the pleural space?

Answer 43

1. Abdominal approach (subcostal) 2. Intercostal

Question 44

What is the abdominal approach to see the pleural space? What will we see? 3

Answer 44

1. We use a curvilinear transducer 2. We will see the inferior area of pleural space 3. We will see windows of the liver and spleen

Question 45

What is the intercostal approach to see the pleural space? 3

Answer 45

1. Use a linear transducer 2. Use ribs as a landmark 3. Pleural space within 1 cm of rib interface

Question 46

What kind of rib landmarks will we see when we take the inter coastal approach? 2

Answer 46

1. Curved hyperechoic lines 2. Posterior shadowing

Question 47

When we take a intercostal approach what will we see? 2

Answer 47

1. Visceral pleura 2. Parietal pleura

Question 48

What does the visceral pleura look like? And how does it move? 2

Answer 48

1. Bright linear interface 2. Moves with respiration (gliding sign)

Question 49

What does the parietal pleura space look like? 2

Answer 49

1. Weak echogenic line or observed 2. Hypoechoic separation of parietal and visceral pleura

Question 50

What is the gliding sign?

Answer 50

The movement of the visceral pleura back and forth as the patient breathes during a live sonographic assessment

Question 51

Label the 1. External oblique 2. Internal oblique 3. Transversus abdominis 4. Transversalis fascia 5. Parietal peritoneum 6. Subcutaneous tissue

Answer 51

Question 52

Label the 1. Anterior layer of rectus sheath 2. Linea alba 3. Parietal Peritoneum 4. Extraperitonal fat 5. Rectus abdominis

Answer 52

Question 53

Label the black areas

Answer 53

Question 54

Label the black areas

Answer 54

Question 55

Label the Quadratus lumborum and the Psoas major

Answer 55