dr/ manal elmahdy. abdominal ultrasound ultrasound is the dominant first –line of investigation...
TRANSCRIPT
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Abdominal ultrasoundDR/ Manal Elmahdy
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Abdominal ultrasoundUltrasound is the dominant first –line of
investigation for a variety of abdominal symptoms .
Preparation :-
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Abdominal ultrasound
Indication: 1 -Localized abdominal pain with indefinite clinical
picture2 -Suspected intra-abdominal abscess
3 -Abdominal mass4 -Abdominal trauma
5 -suspected cholecystitis6 -Jaundice
7 -Liver cirrhosis 8 -Suspected metastasis
9 -Renal pain
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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 intercostal scaning.
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General points on upper abdominal techniqueDeep 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 .
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Liver RT lobe RT lobe
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Liver The diaphragm is shown to the left
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Liver Left lobe of the liver, ligamentum venosum, and caudate lobe of the liver anterior to the inferior vena cava
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Liver Middle hepatic vein draining into the inferior vena cava.
The homogeneous liver texture is well seen
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Liver The right hepatic vein drains into the inferior vena cava
The liver parenchyma shows the portal and hepatic vascular structures within
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Hepatic veins Hepatic veins
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CBD
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Gall bladder
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Gall bladder
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Benign focal liver diseases
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Simple cysts
• Common • Congenital from abnormal development of a biliary radicle• Acquired from trauma or previous infection • Asymptomatic , unless large cause mass effect
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Ultrasound appearance • Peripheral small cysts may be missed on U.S
Three characteristic signs :- • Anechoic• Well defined capsule• Exhibits posterior
enhancement
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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
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Polycystic liver• Usually accompanied by polycystic kidney • Rarely affect the liver alone
Clinical picture :-• Usually asymptomatic• Easily palpable • Very distended abdomen if kidneys affected
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Ultrasound appearance
• Multiple • Often separated cysts • Variable sizes throughout the liver
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Hydatid ( echinococccal ) cyst
Caustive organism :- • Echinococcus granulosus
• Slow growing , enlarge at a rate of 1 cm / year until they become symptomatic
•
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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
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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
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Hydatid ( echinococccal ) cyst
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Abcesses
Amebic abscess , caused by Entamoeba histolytica
Pyogenic abscess caused by Aerobic streptococci
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Clinical picture
• Fever • RUQ pain • Vomiting
Clinical picture is an important as abscess can be similar to another lesions
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Ultrasound appearance
• Very early stage :- hypoechoic or isoechoic solid focal lesion which is zone of nfected , oedematous liver tissue
•As the infection develop :- the abscess appear full of homogenous echoes from pus
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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
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Haemangioma
• Affects any age • F > M• Common • Benign lesion • Solitary or multiple • Highly vascular• Small in size is asymptomatic
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Ultrasound appearance
• Samall one :- hyperechoic , rounded , well defined • Larger one :- hypoechoic or 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
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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
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Ultrasound appearance • Usually solitary • Encapsulated• Small one is homogenous with smooth echopattern• Large one is heterogenous echotexture due to haemorrhage or necrosis.
•
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Focal fatty infilteration
Deposition of fat to certain focal area of the liver Predisposing factors :-• Obesity • Alcoholism• Pregnancy • Diabetes • Certain drugs
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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 1. Anterior to porta hepatis2. Left lobe 3. Caudate lobe
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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 hypoechoic neoplastic lesion • Common sites :- as focal fatty infilteration
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Lipoma • Rare benign tumor • Similar to focal fatty infilteration on sonographic appearance , how can you differentiatie ???
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Hepatic calcification
• Result from some pathological conditions
• It may be 1. Focal , seen with end stage abscess , haematoma
or granuloma 2. 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
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Hepatic calcification
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Hepatic calcification
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Thank you