DR/ Manal Elmahdy. Abdominal ultrasound Ultrasound is the dominant first –line of investigation...

Abdominal ultrasoundDR/ Manal Elmahdy

Abdominal ultrasoundUltrasound is the dominant first –line of

investigation for a variety of abdominal symptoms .

Preparation :-

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

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.

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 .

Liver RT lobe RT lobe

Liver The diaphragm is shown to the left

Liver Left lobe of the liver, ligamentum venosum, and caudate lobe of the liver anterior to the inferior vena cava

Liver Middle hepatic vein draining into the inferior vena cava.

The homogeneous liver texture is well seen

Liver The right hepatic vein drains into the inferior vena cava

The liver parenchyma shows the portal and hepatic vascular structures within

Hepatic veins Hepatic veins

CBD

Gall bladder

Gall bladder

Benign focal liver diseases

Simple cysts

• Common • Congenital from abnormal development of a biliary radicle• Acquired from trauma or previous infection • Asymptomatic , unless large cause mass effect

Ultrasound appearance • Peripheral small cysts may be missed on U.S

Three characteristic signs :- • Anechoic• Well defined capsule• Exhibits posterior

enhancement

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

Polycystic liver• Usually accompanied by polycystic kidney • Rarely affect the liver alone

Clinical picture :-• Usually asymptomatic• Easily palpable • Very distended abdomen if kidneys affected

Ultrasound appearance

• Multiple • Often separated cysts • Variable sizes throughout the liver

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

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

Hydatid ( echinococccal ) cyst

Abcesses

Amebic abscess , caused by Entamoeba histolytica

Pyogenic abscess caused by Aerobic streptococci

Clinical picture

• Fever • RUQ pain • Vomiting

Clinical picture is an important as abscess can be similar to another lesions

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

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

Liver abscess

Haemangioma

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

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

Haemangioma

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

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

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

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

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

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

Hepatic calcification

Hepatic calcification

Thank you