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Abdominal ultrasound

Abdominal ultrasound. DR/ Manal Elmahdy. Abdominal ultrasound. Ultrasound is the dominant first –line of investigation for a variety of abdominal symptoms . Preparation :-. Abdominal ultrasound. Indication : 1- Localized abdominal pain with indefinite clinical picture

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Abdominal ultrasound

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  1. Abdominal ultrasound DR/ ManalElmahdy

  2. Abdominal ultrasound Ultrasound is the dominant first –line of investigation for a variety of abdominal symptoms . Preparation :-

  3. Abdominal ultrasound Indication : 1- Localized abdominal pain with indefinite clinical picture 2- Suspected intra-abdominal abscess 3- Abdominal mass 4- Abdominal trauma 5- suspected cholecystitis 6- Jaundice 7- Liver cirrhosis 8- Suspected metastasis 9- Renal pain

  4. General points on upper abdominal technique • Scan in a systematic way . • Scan any organ in at least two planes , at right angle to each other. • Scan the patient in an at least two positions. • Use the combination of sub- and intercostalscaning.

  5. General points on upper abdominal technique • Deep inspiration is useful in a proportion of patients but not all. • Position old and ill patient in a comfortable position. • Increase the confidence level of your scan by utilising available facilities as changing transducers .

  6. Liver RT lobe RT lobe

  7. Liver The diaphragm is shown to the left

  8. Left lobe of the liver, ligamentumvenosum, and caudate lobe of the liver anterior to the inferior vena cava Liver

  9. Liver Middle hepatic vein draining into the inferior vena cava. The homogeneous liver texture is well seen

  10. Liver The right hepatic vein drains into the inferior vena cava The liver parenchyma shows the portal and hepatic vascular structures within

  11. Hepatic veins Hepatic veins

  12. CBD

  13. Gall bladder

  14. Gall bladder

  15. Benign focal liver diseases

  16. Simple cysts Common Congenital from abnormal development of a biliaryradicle Acquired from trauma or previous infection Asymptomatic , unless large cause mass effect

  17. Ultrasound appearance Peripheral small cysts may be missed on U.S Three characteristic signs :- Anechoic Well defined capsule Exhibits posterior enhancement

  18. Complex cysts Due to haemorrhage or infection in a simple cyst Ultrasound appearance:- Low level , fine echoes within the cyst Thin septum within the cyst

  19. Polycystic liver Usually accompanied by polycystic kidney Rarely affect the liver alone Clinical picture :- Usually asymptomatic Easily palpable Very distended abdomen if kidneys affected

  20. Ultrasound appearance Multiple Often separated cysts Variable sizes throughout the liver

  21. Hydatid ( echinococccal ) cyst Caustive organism :- Echinococcusgranulosus Slow growing , enlarge at a rate of 1 cm / year until they become symptomatic

  22. Hydatid ( echinococccal ) cyst Diagnosis is an important Why ???? Because aspiration may spread the parasite by seeding along the needle track if the operator is unaware of the diagnosis

  23. Ultrasound appearance Well defined cyst Multilocular > unilocular Usually large in size Daughter cysts within larger cysts ( multiseptated cyst ) , give honey comb appearance Rim like cyst calcification in 30 % Waterlily sign

  24. Hydatid ( echinococccal ) cyst

  25. Abcesses Amebic abscess , caused byEntamoebahistolytica Pyogenic abscess caused by Aerobic streptococci

  26. Clinical picture Fever RUQ pain Vomiting Clinical picture is an important as abscess can be similar to another lesions

  27. Ultrasound appearance Very early stage :- hypoechoic or isoechoicsolid focal lesion which is zone of nfected , oedematous liver tissue As the infection develop :- the abscess appear full of homogenous echoes from pus

  28. Ultrasound appearance At late stage :- appearance of fluid content with debris The margin of the abscess is irregular and often ill defined 30 % of amebic abscess may contain gas

  29. Liver abscess

  30. Haemangioma Affects any age F > M Common Benign lesion Solitary or multiple Highly vascular Small in size is asymptomatic

  31. Ultrasound appearance Samall one :-hyperechoic , rounded , well defined Larger one :-hypoechoicor hyperechoic or heterogenous ( mixed echo pattern ) Posterior acoustic enhancement is common Usually appears avascular on color doppler as blood within the haemangioma is very slow flowing

  32. Haemangioma

  33. Adenoma Benign focal lesion Consists of a cluster of atypical liver cells , within this may be pools of bile or focal areas of haemorrhage or necrosis Clinical picture:- Associated with oral contraceptive pills In young women pain May be palpable In rare cases malignant changes occur

  34. Ultrasound appearance Usually solitary Encapsulated Small one is homogenous with smooth echopattern Large one is heterogenousechotexture due to haemorrhage or necrosis.

  35. Focal fatty infilteration Deposition of fat to certain focal area of the liver Predisposing factors :- Obesity Alcoholism Pregnancy Diabetes Certain drugs

  36. Focal fatty infilteration Ultrasound appearance Oval or rectangular hyperechoic focal area of liver dosen’t display any mass effect May simulate a focal mass e . g metastasis Usually takes three parts Anterior to portahepatis Left lobe Caudate lobe

  37. Focal fatty sparing Area spared from fat in diffusely fatty , hyperechogenic liver Ultrasound appearance :- Regular hypoechoic area ( compared to the echogenicty of fatty liver ) with no mass effect . Can mimic a hypoechoicneoplastic lesion Common sites :- as focal fatty infilteration

  38. Lipoma Rare benign tumor Similar to focal fatty infilteration on sonographic appearance , how can you differentiatie ???

  39. Hepatic calcification Result from some pathological conditions It may be Focal , seen with end stage abscess , haematoma or granuloma Linear , following the course of portal tract , seen with old T. B Ultrasound appearance :- Highly echogenic focal or linear structures cast a strong and definite shadow

  40. Hepatic calcification

  41. Hepatic calcification

  42. Thank you

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