aorta, kidneys, bladderceliac trunk common splenic artery hepatic artery. splenic vein celiac trunk...
TRANSCRIPT
Nilam J. Soni, MD, MScAssociate Professor of Medicine
Divisions of Hospital Medicine and Pulmonary/Critical Care MedicineDepartment of Medicine
University of Texas Health Science Center San Antonio
Abdominal Ultrasound :
Aorta, Kidneys, Bladder
Low-frequency Transducers
Phased-array Curvilinear
Anatomy of Aorta
From Point-of-Care Ultrasound, 1st edition, 2014
Image AcquisitionTransverse Longitudinal
Transverse Longitudinal
Complete Exam of Aorta
From Point-of-Care Ultrasound, 1st edition, 2014
Celiac Trunk SMA
From Point-of-Care Ultrasound, 1st edition, 2014
Celiac Trunk – “Seagull Sign”
Celiac Trunk
Splenic ArteryCommon Hepatic Artery
Celiac Trunk – “Seagull Sign”
Celiac Trunk
Splenic ArteryCommon Hepatic Artery
Splenic Vein
Celiac Trunk
Aorta
SMA
Proximal Aorta
From Point-of-Care Ultrasound, 1st edition, 2014
Proximal Aorta
From Point-of-Care Ultrasound, 1st edition, 2014
Au
SMA
Renal ArteriesIVC
Splenic Vein
Vertebral Body
From Point-of-Care Ultrasound, 1st edition, 2014
Mid-Abdominal Aorta
Proximal Aorta
Distal Aorta
Right and Left Common Iliac Arteries
From Point-of-Care Ultrasound, 1st edition, 2014
Distal Aorta
From Point-of-Care Ultrasound, 1st edition, 2014
Abdominal Aortic Aneurysm?
Abdominal Aortic Aneurysm?
Measurement of Aortic Diameter• Measure outer wall to
outer wall in both transverse and longitudinal views
• Normal < 3cm proximally (<2cm distally)
• Diameter >4.5cm referral to vascular surgery
AAA?
From Point-of-Care Ultrasound, 1st edition, 2014
AAA?
From Point-of-Care Ultrasound, 1st edition, 2014
Aorta Pearls• Bowel gas limits visualization
– NPO– Firm pressure or sweep transducer
• Types of AAA– Fusiform– Saccular– (Pseudoaneurysm)
• Measure in transverse and longitudinal planes
Kidney Anatomy
■ 2 Anatomical Sections ➔ Sonographic “Double Density” ■ Renal Parenchyma = Cortex + Medulla ■ Renal Sinus = Fatty tissue + Calyces + Vessels
Image Acquisition
From Point-of-Care Ultrasound, 1st edition, 2014
Normal Kidneys1. Perinephric fat + Gerona's fascia =
hyperechoic2. Renal cortex = hypoechoic3. Medullary pyramids = hypo-/anechoic4. Renal sinus = hyperechoic with small
pockets of urine (not contiguous) and vessels
5. Ureter normally obscured by bowel gas
Normal
Renal Pathologies■ Atrophy ■ Hydronephrosis ■ Stone ■ Cysts ■ Mass
Atrophic Kidney
Hydronephrosis
■ Mild = central dilation with preservation of renal pyramids ■ Moderate = blunting of renal pyramids, rounding of calices,
“bear-claw” appearance, preservation of cortex ■ Severe = cortical thinning, calyceal ballooning, distortion of
architecture
From Point-of-Care Ultrasound, 1st edition, 2014
Mild Hydronephrosis
From Point-of-Care Ultrasound, 1st edition, 2014
Severe Hydronephrosis
From Point-of-Care Ultrasound, 1st edition, 2014
Bladder
■ Indications ■ Estimate bladder volume
■Confirm catheter placement
■Ureteral obstruction (ureteral jets) ■Detect stones
■Work-up for renal failure
Bladder Anatomy■ Posterior and inferior to
symphysis pubis (tilt US beam into pelvis)
■ Ureters enter trigone on postero-inferior wall
■ Prostate normally <5cm transversely
From Point-of-Care Ultrasound, 1st edition, 2014
Image Acquisition
From Point-of-Care Ultrasound, 1st edition, 2014
Longitudinal ViewTransverse View
Normal Male BladderTransverse View
Foley + Decompressed Bladder
Distended Bladder + Foley + Enlarged Prostate
Bladder Volume EstimationVolume (ml) = 0.75 x width x length x height
Longitudinal ViewTransverse View
Nilam J. Soni, MD, MScAssociate Professor of Medicine
Divisions of General & Hospital Medicine / Pulmonary & Critical Care Medicine University of Texas Health San Antonio
Ultrasound-guided Lumbar Puncture
AnatomyLumbar Spine -Spinal cord ends at
L1-L2 in adults -Lumbar puncture
can be safely performed below L2
L1
L2
L3
L4
L5
L1
L2
L3
L4
L5
Lumbar SpineTransverse Plane Longitudinal Plane
Spinous Process
Spinous Process
Spinous Process Interspinous
Space
Lumbar Puncture Mapping
Transverse Plane
Midline Shadow = Spinous Process
L3 – L4
Transverse Plane
Lumbar Puncture Site Mapping
Longitudinal Plane
Lumbar Puncture Mapping
L5 = Deep and Small
Lumbar Puncture Mapping➢Mark 2 widest interspinous spaces➢Patient must remain in position➢Higher success in sitting position
Lumbar Spine
Lumbar Spine
Paramedian View
PITFALL:• Lamina / articular
processes can be mistaken for spinous processes
• No muscle should be seen superficial to spinous processes
Lamina / articular processes
Erector spinae muscles
Lumbar Spine
Lumbar Spine
Paramedian View
Questions?