Abdomen Scan

Overview

Terminology

  • U/S Whole Abdomen = All abdominal organs
  • U/S Upper Abdomen = All abdominal organs - (Bladder & Reproductive orgs)
  • U/S KUB = Kidneys + Bladder + Reproductive orgs

Echogenicity

Relative echogenicity on ultrasound (high to low):

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(Ref: radiopedia)

Liver

Overview

  • Subcostal: Transverse & longitudinal view of RL & LL (LL must includes caudate lobe)

  • Intercostal: RL

Beware

Blind spot of liver at “superior portion of Rt lobe”

Figure 1: Liver scan plane [1]

Measure

  • Normal liver span: 15 - 17 cm (sagital, at MCL)

  • Enlarge: > 15.5 cm

  • Hepatomegaly: confident if liver extend to caudal of Rt kidney

(Ref from [2])

View: Longitudinal

Figure 2: Superior border: longitudinal view [1]
Figure 3: Inferior border: longitudinal view [1]
Figure 4: Superior border: drawing [1]
Figure 5: Inferior border: drawing [1]

View: Transverse

Figure 6: Left lobe: transverse view [1]
Figure 7: Right lobe: transverse view [1]
Figure 8: Transverse view drawing [1]

Gallbladder

  • View: transverse & longitudinal

  • Measure:

    • Diameter: long (9 - 11 cm), TV (< 4 cm)
    • Wall thickness at anterior wall in TV section (< 3 mm)
Figure 9: Gallbladder: a shot to take [1]

Porta Hepatis

Measure: CBD & PV

CBD

  • Measure: internal diameter
    • < 0.6 cm (< 0.9 for post-cholecystectomy)
    • Age > 60 yrs can dilate 0.1 cm / 10 yrs

PV

  • Measure: internal diameter < 13 mm
  • Flow direction: hepatopetal ? (toward liver) or hepatofugal ? (away from liver)

View: CBD & PV

View: longitudinal scan (with lt lateral decubitus) to see porta hepatis Figure 10

Figure 10: Porta hepatis: CBD and PV [1]

Tips: identifying CBD

  • CBD will appear anterior and parellel to PV and IVC.
  • Color doppler will show no flow at CBD.

Pancreas

View

View: transverse view, angle the probe slightly upward to the liver.

  • use splenic vein as a land mark

  • The money shot of the pancrease is shown in Figure 11.

Figure 11: Pancrease: transverse view [3]
Figure 12: Pancrease: drawing in transverse view [3]

Finding pancreas

Figure 13: Pancrease: landmark vessels [1]
Figure 14: Pancrease: scanning from rostal to caudal [1]

Tips

Pancrease is best examined in fasted patient.

If bowel gas obstruct the view, try:

  • Examine after the patient change position:

    • From lateral decubitus to supine, or
    • From supine to upright (sit).

  • Use acoustic windows:

    • Let the patient drink some water to fill in the stomach.

    • View through the liver.

References

[1]
B. Block, Abdominal ultrasound: Step by step, 3rd edition, Thieme, Stuttgart New York Delhi Rio de Janeiro, 2016.
[2]
H. Tchelepi, P.W. Ralls, R. Radin, E. Grant, Sonography of diffuse liver disease, Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine. 21 (2002) 1023-1032; quiz 1033-1034. https://doi.org/10.7863/jum.2002.21.9.1023.
[3]
Color atlas of ultrasound anatomy, Thieme, Stuttgart, 2004.