Ultrasound Abdomen

Greater than reference structure

Less than reference structure

Absence of echoes.

Equal echogenicity

Renal sinus – Pancreas – Liver – Spleen – Renal Cortex.

Localization of liver by functional distribution of portal veins.

Receives branches from both, right and left portal veins and getting drained by emissary veins.

Glisson’s capsule or Vesceral peritoneum.

Parietal peritoneum.

Liver invaginates into peritoneum, which covering the liver surface.

Portal v. flow to transducer.

Portal v. flow away from transducer.

Left lobe, Right lobe, caudate lobe.

Caudate, left lateral superior, left lateral inferior, left medial superior, left medial inferior, right anterior superior, right anterior inferior, right posterior superior, right posterior inferior.

Hepatic veins.

Portal veins.

Portal vein, hepatic artery, bile duct.

Imaginary line from GB to IVC, middle hepatic vain is landmark for it.

Right and left lobes of the liver.

Right anterior segment from left medial segment.

Coronal division of the right lobe of the liver, dividing right lobe to anterior and posterior, right hepatic vein is landmark for right Intersegmental fissure.

Sagittal division of the left lobe of the liver, divides the left lobe to medial and lateral, the left hepatic vein, ligamentum teres, falciform ligament, assending segment of the left portal vein are landmarks.

Remnant of ductus venosus, conducts blood from the left portal vein to IVC, separates medial segment of left lobe from caudate lobe.

Posteriorly by IVC.

Anterioinferiorly by proximal left portal vein.

Anteriolaterally by ligamentum venosum.

Inferiorly by main portal vein.

Posterior portion of liver that is not covered by peritoneum.

Reflection of parietal peritoneum onto liver surface, visceral peritoneum.

Reflection or coronary ligaments at each corner of the bare area.

Inferior tongue like projection, superior-inferior increasement. In right lobe of the liver, beyond lower pole of right kidney. More in women.

If its greater than 15.5cm

Solitary, in right lobe, caused by bacteria that reaches the liver via the bile ducts, portal veins, hepatic arteries or lymphatic channels.

Hypoechoic, rounded, fluid-filled masses with variable degrees of internal echoes or debris, may be seen as a result of gas-producing organism.

Hypoechoic liver parenchyma, liver enlargement, Hyperechoic portal vein walls.

Hyperechoic liver parenchyma, small liver, Hypoechoic portal vein walls (decreased echogenicity).

The patient is generally imunocompromised. Wheel within a wheel, bull’s eye, Hypoechoic mass.

Due to protorzan parasites, entameoba histolytica, enter the intestinal tract and resides in colon. Get’s to liver via portal vein. Generally occurs in the right lobe of the liver. Indirect hemagglutination test is used for diagnosis.

Round or oval shaped Hyperechoic mass, absence of prominent wall, fine low-level internal echoes, distal enhancement, contiguous with diaphragm.

Prevalent in sheep and cattle raising countries. The embryos travel from gastrointestinal tract to the liver via portal vein.

Large (pericyst) cyst, with one or more daughter cysts (endocysts). Fine internal echoes (Hydatid sand), ends as collapsed calcified mass.

Most common parasitic infection worldwide. Portal vein occlusion by larvae which leads to portal hypertension, splenomegaly, varices and ascites.

Sonographically appears as distended, echogenic debris-filled intrahepatic portal vein.

Most common organism causing infection in imunocompromised (or AIDS) patients.

Nonshadowing echogenic foci.

Regions of increased echogenicity on normal liver, commonly at porta hepatis.

Regions of normal liver that will appear as Hypoechoic masses over dense fatty liver, commonly seen at adjacent to the gallbladder.

Is deposit of glycogen in the hepatocytes of the liver and convoluted tubes of liver

Associated with Glycogen storage disease. Usage of oral contraceptive agents

Due to hemorrhage and malignant transformation risk surgical resection is recommended

Is hard to distinguish from focal nodular hyperplasia

Hepatocellular death, fibrosis and regeneration

Hepatomegaly, jaundice, ascites

Ascites, splenomegaly, varices.

• Associated with Hepatocellular carcinoma, metastatic liver disease, pancreatic carcinoma,
• pancreatitis ….

Intraluminal thrombus, increased vein diameter, cavernous transformation.

Occlusion of hepatic veins.

Hepatic vein thrombosis, ascites, Hepatomegaly (acute phase), caudate lobe enlargement (chronic phase), portal hypertension.

Most common benign liver tumors. Usually small and asymptomatic. May enlarge during pregnancy or estrogen replacement therapy.

Small, well-defined, Hyperechoic mass with posterior acoustic enhancement.

Common benign liver mass.

Solitary mass, less than 5 cm in diameter, central fibrous scar. Difficult to differentiate from adjacent liver parenchyma.

Hemangioma, hepatic Lipoma, echogenic metastasis, focal fatty infiltration, they all appear well-defined Hyperechoic masses within the liver.

Most common primary malignant tumor of the liver.

Alcoholic cirrhosis, chronic hepatitis B and C. Its seen as an Hypoechoic mass.

Portocaval shunt, Proximal splenorenal shunt, Distal splenorenal (Warren) shunt, Mesocaval shunt, Transjugular intrahepatic portosystemic shunt.

Demonstration of flow in shunt, Hepatofugal portal vein flow.

Gallbladder neck fold.

Gallbladder fundus fold.

Wall-echo-shadow (WES sign) or double arc shadow sign.

Obstructed bile duct should increase, non-obstructed bile duct should decrease.

Obstructive jaundice, intrahepatic cholestasis, biliary tree obstruction.

If its >3mm it is abnormal.

Cholecystitis (inflammation), ascites, hypoalbuminemia, hepatitis, congestive heart failure, renal disease, AIDS, sepsis.

Mobile, echogenic structure with posterior acoustic shadowing.

Cholesterol, calcium bilirubinate, calcium carbonate.

Obstructed cystic duct by a precipitated stone, obstruction of venous drainage, inflammation of GB wall, various degrees of necrosis and infection.

RUQ tenderness, guarding, fever, chills, leukocytosis.

Gallstones, sonographic Murphy’s sign, diffuse wall thickening, gallbladder dilatation, and sludge.

Infection associated with gas-forming bacteria, in wall of GB.

Gas shadowing from the wall of the GB.

Distended, noninflamated GB due to obstruction of the cystic duct. Trapped bile is reabsorbed and the GB is filled with a clear mucinous secretion.

Asymptomatic, may present as a palpable, RUQ mass. Diagnosis should be suspected on ultrasound when stone is noted in an enlarged, non-tender GB.

Are diverticula within the wall of GB.

Pathology associated with adenomyomatosis.

Sludge and stones accumulate within the sinuses, and present as focal wall thickening. Echogenic foci are visible within the thickened wall, reverberation artifact.

Intraluminal mass, asymmetric wall thickening or a mass-filled GB.

Liver metastases, lymphadenopathy, and bile duct dilatation.

Gallstones (choledocholithiasis) and carcinoma of the pancreas.

Alkaline phosphate, conjugated (direct) bilirubin, gamma glutyml transpeptidase.

Shotgun sign and parallel channel sign (dilated bile duct adjacent to a portal vein).

Irregular path compared to portal veins, stellate or star shape configuration of bile ducts and acoustic enhancement associated with bile ducts.

Extrahepatic bile duct obstruction, because of a stone within the cystic duct. The stone causes external mechanical compression of the CHD.

Intrahepatic bile duct dilatation, normal size CBD, large stone in the cystic duct of the GB.

CHD, Cystic duct, CBD

Intrahepatic biliary duct dilatation. Specific type of cholangiocarcinoma. Located at the hepatic helium, at junction of the right and left hepatic ducts.

Variable length echogenic foci in the distribution of the biliary tree, resulting in acoustic shadowing and reverberation artifact (comet-tail).

Commonly seen in the helium of the liver, direction of bile flow.

Seen after endoscopic retrograde cholangiopancreatogram (ERCP). It’s also can be due to surgically created biliary-enteric anastomosis, incompetence of the sphincter of Oddi, wall erosion by gallstone or ulcer into the CBD.

Usually occur in Asian women, pain, jaundice, abdominal mass.

Two cyst-like structures in RUQ: GB and dilated CBD.

Saccular, communicating intrahepatic bile duct dilatation.

Infantine polycystic kidney disease, congenital hepatic fibrosis, choledochal cysts.

Enlarged, nondiseased GB, associated with an extrinsic obstruction of the distal CBD.

Fluid field level that produces acoustic shadowing.

Uncommon cancer, ulcerative colitis, sclerosing colangitis, Caroli’s disease, choledochal cyst, parasitic infections.

Commonly located in CHD and CBD.

Specific type of cholangiocarcinoma at hepatic helium, intrahepatic bile duct dilatation without extrahepatic bile duct dilatation.

Anterior to IVC

Medial to second portion of the duodenum

Posterolateral to the head of the pancreas

Anteriolaterally to the head of the pancreas

Posterior to the neck of the pancreas

Posterior to SMA and SMV

Posterior to the body of pancreas

Superior to pancreas

Posterior to the first portion of the duodenum

Posteroinferior to the pancreas

Inferior to the pancreas

Anterior to the third portion of the duodenum

To the right of the SMA

Combination of SMV and Splenic vein

Alcohol abuse and biliary calculi most causes

Diagnosed by clinical and lab findings

Normal pancreas view

Decreased echogenicity, increased gland size

Progressive, irreversible destruction of pancreas

Sonographically: small echogenic gland, calcification, pancreatic duct dilatation, pseudocyst formation

Solid focal Hyperechoic mass usually in the head of the pancreas

Dilated biliary system, dilated pancreatic duct, liver metastases, ascites, lymphadenopathy, pseudocyst formation

Associated with Courvoisier’s sign: palpable, nontender gallbladder due to pancreatic head obstruction, biliary tract is obstructed resulting in jaundice.

Head, neck, body, tail, uncinate process.

Endocrine portion of the pancreas consists of the islet cells of Langerhans which secretes insulin.

Divides to left gastric, common hepatic and Splenic artery

Divides to proper hepatic and gastroduodenal arteries

Join to form Main portal vein

Small, well circumscribed masses, usually in pancreatic body and tail

Most common benign tumor of pancreas, but can be malignant too

Insulinoma and Gastrinoma most common tumors

Hyperinsulinism and hypoglycemia

Associated with gastric hypersecretion and peptic ulter disease – Zollinger-Ellison syndrome

Pituitary adenoma, parathyroid adenoma, medullary thyroid carcinoma, pancreatic islet cell tumor, pheochromocytoma, ganglioneuromatosis.

Collection of pancreatic fluid encapsulated by fibrous tissue

Caused by acute pancreatitis, chronic pancreatitis, trauma, pancreatic cancer

Pancreas(most common), intraperitoneal, retroperitoneal, intraperchymal (liver, spleen, kidney), thorax (passage through diaphragm)

Breakdown of hemoglobin, formation of bile pigment and antibodies, reservoir for blood.

Anterior, medial to Splenic helium

Posterior to stomach

Inferior, medial to spleen

Anterior to upper pole of kidney

Cystic degeneration of infarcts or hematomas

Cysts associated with adult polycystic kidney disease

Parasitic cysts of the spleen (echinococcal cysts)

Epidermoid cyst of the spleen

Pancreatic pseudocyst

Peripheral wedge-shaped Hypoechoic lesion

Splenic trauma in which splenic capsule remains intact

Splenic trauma in which splenic capsule ruptures

Autosomal dominant polycystic kidney disease and Von Hippel-Lindau syndrome

Cystic fibrosis is characterized by viscous secretion

Appearance of pancreas in patent with cystic fibrosis

Echogenic thrombus within vessel lumen, increased portal vein diameter, portosystemic collateral circulation, cavernous transformation

Diaphragm, quadratus lumborum muscle, psoas muscle

Anterior vein exit, middle artery enter, posterior ureter exit

Main renal artery brunches from aorta, after entering the kidney it divides into five segments, which divide into interlobar arteries

Seen between medullary pyramids. At base of the medullary pyramids arcuate arteries branch perpendicular from interlobar arteries, and run parallel to the renal capsule

Branch off the arcuate arteries and run perpendicular to renal capsule

Collecting tubules, Hypoechoic triangles in newborns and infants, not visualized in adults

Oligohydramnios and pulmonary hyperplasia, incomplete wit life

Uterine duplication (bicornuate uterus) and seminal vesicle agenesis

Kidney ascends to other side, ureters are in proper places on bladder, displaced kidneys ureter crosses midline, sonographically two kidneys on one side of abdomen

Kidneys fuse in the pelvis, one kidney ascends to normal position and carries the other across the midline, sonographically two kidneys fused at the upper and lower poles on one side

Fused lower poles, kidney in retroperitoneum, lower poles are closer to the midline, isthmus is anterior to distal aorta, mimics lymphadenopathy

Upper pole collecting system

Complete duplication of ureters, the upper one always enters the bladder in ectopic location and there is a complication named uretrocele: cystic dilation.

Posterior urethral valves, flap of mucosa with a slit like opening in prostatic urethra area

Dilated urinary bladder, hydroureter, hydronephrosis, possible urinoma

Thickening of the lateral aspect of the left kidney

Triangular echogenic area in anterior aspect of the right upper pole of kidney

Hypertrophy of renal cortical parenchyma located between two medullary pyramids. Appearance of mass effect although the echogenicity is equal to cortical tissue

Common anomaly, renal pelvis protrudes outside the renal hilum. Sonographically: cystic collection medial to the renal hilum

Round or ovoid shape, thin wall thickness, anechoic, acoustic enhancement

Multiple thick septations, irregular walls, large solid components

Bilateral enlargement of adult kidney caused by multiple cysts of varying sizes. Cysts may be seen in liver, pancreas spleen

Also associated with aneurysm development, cerebral (berry) aneurysm of the circle of Willis

Bilaterally enlarged echogenic kidneys with loss of the cortical medullary boundary

Associated with: lung hypoplasia, periportal hepatic fibrosis, olingohydramnios

Dysplastic cystic dilation of the collecting tubules of the medullary pyramids

Most common cause of an abdominal mass in newborn

Cysts of varying shape and size, absence of communication between cysts, absence of renal sinus, absence of renal parenchyma

Column of Bertin, dromedary hump, fetal lobation

Patient on chronic hemodialysis. This cyst may hemorrhage resulting in flank pain, hematuria and intracystic echogenic collections.

Slightly higher incidence of renal cell carcinoma

Multisystemic disorder associated with renal cyst formation and multiple renal angiomyolipomas.

Hypernephromas – adenocarcinomas - von Growitz tumor

Adult polycystic kidney disease, acquired cystic disease, von Hippel-Lindau syndrome, tuberous sclerosis

Encapsulated, solid mass, Hypoechoic relative to normal, adjacent renal parenchyma.

Need to evaluate: ipsilateral renal vein and IVC for tumor invasion, Contralateral kidney and renal vein, retroperitoneum for lymphadenopathy, liver for metastases

Fat containing tumor, propagation speed artifact

Transitional cell carcinoma, blood clots, fungal balls – same similar appearance

Wilm’s tumor (nephroblastoma), most patients less than 3 years

Renal enlargement, Hypoechoic parenchyma, absence of sinus echoes

Presence of pus in dilated renal collecting system, secondary to infected hydronephrosis

Dependent echoes within dilated pelvocaliceal system, shifting urine-derbis level, gas shadowing from infection

Malignant tumor associated with urinary collecting system, usually in bladder, can arise in the ureter and renal pelvis

Most common explanation for bilateral renal masses

Hyperechoic, nonshadowing masses. Same appearance as angiomyolipomas, blood clots, Pyogenic derbis, sloughed papilla, nonshadowing renal stones

REnal cell carcinoma, hemangioma, pheochromocytoma, pancreatic cystadenoma/cystadenocarcinoma, adenoma, islet cell tumor, cysts associated with variety of organs.

Portal vein thrombosis

Cirrhosis, Scistosomiasis

Budd-Chiari syndrome

IVC or renal vein extrinsic compression, nephritic syndrome, renal tumors, renal allografts, trauma

Dilated thrombosed renal vein, absence of venous flow within the kidney, enlarged Hypoechoic kidney, high resistive renal artery waveform

Acute tubular necrosis is the most common cause. Cause includes shock, trauma, sepsis and drug toxicity. Renal enlargement and increased resistive index may be seen associated with ATN

Diagnosed using an intrarenal resistive index (RI) grater than 0.7

Resistive index less than 0.7

Common congenital anomaly.

Associated with Contralateral uretropelvic junction obstruction

Most common cause of obstruction in patients with acute flank pain.

URetrovesical junction (the most common), uteroppelvic junction, ureteric obstruction at the level of pelvic inlet

Peak S Fr-End S Fr/Peak S Fr

Demonstrates abnormally low resistive arterial waveform flow pattern, which means increased and sustained diastolic flow

Demonstrates increased velocity waveform flow, pulsality and spectral broadening due to turbulence

Kidney size less than 9cm in length, peak velocity of main renal artery >180cm/sec, renal artery/aorta ratio >3.5, intrarenal parvus tardus waveform

Round, cystic structures that project into the bladder lumen at the uretrovesical junction

Suspends the bladder, connects the apex to umbilicus.

Lies in the space of Retzius

Dilation of the median umbilical ligament.

Echofree tubular structure in lower abdomen, from umbilicus to the dome of the bladder

Placed in IVC to prevent the ascension of thrombus into the lungs

Location is determined by ultrasound inferior to renal vein, can detect complications: thrombosis around the filter or perforation around the filter or through IVC wall that may be associated with retroperitoneal hematoma.

Main renal artery – segmental artery – interlobar artery – arcuate arteries – interlobar arteries

Positioned between the medullary pyramids

Parallel to the base of the medullary pyramids

Pneumocystic carinii, fatty liver infiltration, hepatitis, non-Hodgkin’s lymphoma, candidiasis, cholangitis, cholecystitis, Kaposi’s sarcoma

Pelvic surgery common complication

Caused by leakage of lymph from a renal allograft, by surgical disruption lymphatic channels

Enlarged transplant, decreased cortical echogenicity, indistinct corticomedullary boundary, prominent hypoechoic medullary pyramids, peritransplant fluid collections

Serum glutamic pyruvic transaminase (SGPT) most specific for Hepatocellular damage.

Wide tissue distribution. Present in liver, heart, skeletal muscle, kidney and brain. AST is non-specific for liver, but it’s very sensitive for liver disease.

Creatinine and blood urea nitrogen are removed by kidney filtration, and in decrease of renal function they increase

Increase is associated with masses: hepaocellular carcinoma, metastatic liver disease, hepatoblastoma

Patient age, prostate volume, benign prostatic hyperplasia, prostate cancer

Anterior to the aorta

Superior to the CT

Posterior to IVC

Medial posterior to the adrenal glands

Suprarenal branch of the inferior phrenic artery

Suprarenal branch of the aorta

Suprarenal branch of the renal artery

Drains directly to IVC

Drains into the left renal vein

Adrenal medulla, organ of Zuckerkandl near the aortic bifurcation, paravertebral sympathetic ganglia

Hypersecretions of catecholamines (dopamine, norepinephrine, epinephrine)

Unilateral mass, no other malignancy history, no biochemical evidence of adrenal hyperfunctioning, adrenal mass less than cm in diameter

Lung, breast, melanoma

Usually seen as an echogenic mass in the adrenal bed, contains both fatty and bone marrow elements, presence of a propagation speed artifact is mass containing fat tissue

Originate from adrenal medulla

Perirenal space, anterior pararenal space, posterior pararenal space

Kidney and ureters, adrenal glands, IVC, aorta, pancreas, portions of duodenum, ascending & descending colon, prostate, lymph nodes, uterus, bladder

Common hepatic artery, left gastric artery, splenic artery

Dilation of all three layers of the aorta, most aortic aneurisms are distal, don’t involve renal arteries

Spindle-shaped dilatation

Localized spherical outpouching of the vessel wall

Injury to the vessel wall where blood extravasates from vessel, the blood surrounding the vessel is retained and walled off by the surrounding tissues

True aneurisms

Commonly found in groin, resulting from catheters to common femoral artery, during angiographic procedures.

Result of dissection of the intima away from the aortic wall, usually stat in the thoracic aorta

Ascending thoracic aorta

Starts in origin of the left subclavian artery

Is seen as a septations dividing the aorta into a true lumen and a false lumen

Branches of the common iliac veins, parallel the spine, and posterior to psoas muscle, superior to the diaphragm

Continues as the azygos vein

Continues as the hemiazgos vein

Originate symmetrically from the aorta, below the origin of the renal arteries

Drains the right ovary or testicle, inserts into the right side of the IVC below the right renal vein

Drains the left ovary or testicle, inserts into the left renal vein, that drains into the IVC

Dense, fibrosis tissue proliferation that is confined to the paravertebral and central abdominal region at the fourth or fifth lumbar vertebra, overlying the aortic bifurcation

Smooth-marinated, hypoechoic soft-tissue mass encasing the aorta and IVC

Usually idiopathic (of unknown origin), causes may include an autoimmune response, drugs, abdominal aortic aneurysm, infection, retroperitoneal malignancy, radiation therapy and chemotherapy

Anterior to the thyroid gland

Anterolateral to the thyroid gland

Lateral to thyroid gland

Posterior to the thyroid gland

Posterior to the thyroid gland

Posterior to the thyroid gland

Embryologically, as primitive cells migrate from the pharyngeal floor to become the thyroid, a residual thyroglossal duct is formed, normally becomes obliterated in fetal life

Congenital anomaly that appears as a superficial cyst in the neck anterior to the trachea and superior to the thyroid. Commonly diagnosed in preschool-aged children or during mid-adolescence, and often following an upper respiratory infection

Most common malignancy (cancer) of thyroid gland, 75-90% of all cases

Spreads through the lympatics to nearby cervical lymph nodes

Hypoechoic thyroid mass and adjacent enlarged cervical nodes

Pituitary adenoma, Parathyroid adenoma, Medullary thyroid carcinoma, Pancreatic islet cell tumor, Pheochromocytoma

young or middle-aged women, associated with hypothyroidism

Remnant of the Mullerian duct.

Small ovoid structure near the head of epididymis

Detached efferent duct, small stalk projecting off the epididymis

Fibrous capsule surrounding the testicle

Extension of the peritoneum into the scrotal chamber, resides along the side of testicle

Inner or visceral layer covers the testis and epididymis

Outer or parietal layer lines the walls of the scrotal chamber, small amount of fluid is commonly seen in this space

Collection of serous fluid in within tunica vaginalis lining the scrotum, blood for hematocete, pus for pyocele

Fluid collection surrounding the testicle, low-level echoes from fibrin or cholesterol Chrystal’s may be visualized within hydrocele

Congenital or acquired.

Often idiopathic, result of trauma, torsion, neoplasm, epididymitis or epididymorchitis

Dilated, tortuous veins of pampiniform plexus, posterior to testis

Associated with male infertility

Caused by incompetent valves in the internal spermatic vein

Commonly appear on the left side, left gonadal vein drains into the left renal vein, patient is upright, performing Vasalva or abdominal compression

Torsion of spermatic cord, epidiymo-orchitis

One to six hours after onset of torsion, testicle becomes enlarged, inhomogeneous and hypoechoic compared to the normal testis

Enlarged epididymis, skin thickening, reactive hydrocele formation

Presence of blood flow in testicle would exclude acute torsion, but presence of flow does not exclude partial torsion. 540 degree s of torsion is considered necessary to completely occlude testicular blood flow

Orchitis and testicular torsion

Inflammatory disease which would cause hypervascularity, increased vascular flow should be noted with color flow

Absence of intratesticular flow

Common genitourinary anomaly. 80% of Undescended testes lie at the level of inguinal canal

Infertility and cancer

Result s from pathologic changes that develop in both the Undescended and Contralateral normal testis after the age of one year.

Increased risk if malignancy

Increased risk if malignancy

Periumbilical pain, leukocytosis, fever, RLQ pain with rebound tenderness

Develops from the obstruction of the appendiceal lumen.

Appendix grate than 6 mm in diameter.

Associated with the presentation of LLQ pain, fever leukocytosis

Thickened bowel or abscess formation in LLQ

Abnormal bowel wall thickening, hypoechoic external rim representing the thickened intestinal wall and an echogenic center relating to the residual gut lumen or mucosal ulceration

Hypertrophy of the circular pyloric muscle, resulting in elongation and constriction of the intestines between the stomach and the first portion of the duodenum.

Neonates present with projective vomiting, palpable “olive-like” abdominal mass

Pyloric muscle thickness >4mm, pyloric channel length >1.2cm, pyloric cross section >1.5cm

Most common cause of obstruction in infants

Intermittent abdominal pain, vomiting, passage of blood through the rectum

Oval, pseudokidney mass, central echoes on longitudinal imaging, sonolucent doughnut or target configuration on cross-sectional imaging

Peripheral zone, transition zone, central zone, fibromuscular stroma

Peripheral zone 70% of cancer, hypoechoic, peripherally-oriented lesion

Fibromuscular stroma non-glandular, anterior portion of the prostate

Pass through the central zone and empties into the urethra

Superior portion of the gland

Inferior portion of the gland

Demarcation between the inner gland and the outer gland

Anteriorly by the pubic bone

Posteriorly by the rectum

Superiorly by the bladder

Inferiorly by the urogenital diaphragm

Produced only by prostatic acinar cells, and rises in relationship to the amount of benign or malignant tissue

Will raise with age, prostate volume, benign prostatic hyperplasia, or prostate cancer

Cancer elevates the PSA level app 10 times compare to benign prostatic hyperplasia

End of the posterior sheath of the rectus muscle, above this line hematomas are confined within anterior and posterior rectus sheath, below this line hematomas protrude posteriorly into the pelvis due to the absence of the posterior rectus sheath

Complex collections containing cystic and solid components, derbis, septations, gas within abscess. Borders are irregular and thick, posterior enhancement.

Fever and leukocytosis

Complications of renal transplantation, gynecologic, vascular or urological surgery. The etiology is leakage of lymph due to surgical disruption of the lymphatic channels

Fluid collections such as loculated ascites, urinomas, hematomas, abscesses. Internal echoes within the fluid collection is sign of abscesses or hematomas

Result from renal trauma, renal surgery, obstructing lesion

Associated with renal transplantation and posterior urethral valve obstruction

Similar to Lymphoceles

Variable, depends on the age of collection, echogenic collections due to rapid fibrin invasion. Gradual hemolysis eventually creates anechoic appearance, calcifications are associated with long-standing hematomas

Percentage of red blood cells per volume of blood, normal range from 40-50%

Indicates red blood cell loss, caused by internal bleeding, iron deficiency and external blood loss

Collection of synovial fluid which is found in the medial aspect of popliteal fossa

May be caused by trauma or rheumatoid arthritis, synovial fluid is very inflammatory and can cause pain. Infection, venous thrombosis or compression of veins causes calf swelling

Rare condition: filling of the peritoneal cavity with mucinous material and gelatinous ascites. Result of mucinous cystadenocarcinoma of the ovary, appendix …

Cause rupture of a mucinous cystadenocarcinoma of the appendix or ovary

Most common cause of adrenal hemorrhage, occurs during the first week of the life, asymptomatic abdominal mass, or mass in the presence of jaundice or anemia

Depends on the age of hematoma

Indication of bowel infarction same as in ulcerative colitis or necrotizing enterocolitis

Linear echogenic branches in the periphery of the liver, echogenic foci within the lumen of the portal vein is seen

Different from biliary gas

Within periphery of liver

Located closer to the liver hilium

Compression of left renal vein between SMA and aorta. Dilated left renal vein compared to right.

Left-sided hematuria, abdominal pain, varicocele formation, infertility

Layered or mantle appearance around vessels of the abdomen

Visualized anterior and posterior to vessels of the abdomen, creating sandwich sign

Thyroid hyperfunctioning, causing diffuse glandular hyperplasia

Exopthalmos, palpable lymph nodes, muscle atrophy, localized myxedema, weight loss, tremors, nervousness

Diffusely enlarged, identical to multinodular goiter, increased vascularity by Doppler

Arises in the left lateral aspect of neck, fromepithelial remnants of the second branchial cleft

Hypoglycemia and hypoechoic mass in the tail of pancreas, tumor in body or tail, causes hypersecretions of insulin that leads to hypoglycemia

Cystic masses associated with pancreas, increased level of serum amylase, in patients without history a history of autosomal dominant polycystic kidney disease

Formed in association with acute or chronic pancreatitis, encapsulated collections of pancreatic enzymes

Predominantly anechoic masses with or without dependent derbis, displaces structures like liver, lesser sac, stomach, left kidney or spleen

Rare fluid collection, arise from the epithelium of the pancreatic duct. Primarily cystic, septations and thick walls, easy confused with pseudocysts

Acute infection of the gallbladder wall, vascular compromise, bacteria produces gas within the wall of the GB

Thickened gallbladder wall, gas within the wall produce comet-tail or reverberation artifact, “ring of air”

High mortality, large percentage are diabetics, RUQ pain, fever, leukocytosis

Splenic vein and SMA join at the confluence adjacent to the head of the pancreas to form MPV

Evaluation methods: direct evaluation, indirect evaluation

Renal artery velocity evaluation

Intrarenal waveform evaluation

Main renal artery systolic velocity, renal artery/aorta velocity ratio, pulsus parvus at tardus, absent early systolic peak, acceleration (internal waveform)

• To determine the degree of stenosis in renal arteries peak systolic velocity of mein renal arteries are
• compared with peak systolic velocity of the aorta. Ratio peak systolic velocity of renal artery divided by peak systolic velocity of the aorta. Greater than 3.5 indicates hemodinamically significant stenosis

The time from beginning of systole to the initial peak velocity

Derived by dividing the acceleration slope by the transmitted frequency

>0.1 or <3.78kHz/sec/MHZ indication of hemodinamically significant renal artery stenosis of 50% grater

Prolonged, or delayed early systolic acceleration

Decreased amplitude and rounding of systolic peak

Postprandial intestinal angina, weight loss

Peak systolic velocity of SMA >275cm/sec with significant stenosis (70%), peak systolic velocity of CT >200cm/sec significant stenosis (70%)

Intestinal angina, two of three arteries supplying mesentery are occluded or significantly stenosed. Arteries are SMA, CT , inferior mesenteric artery

Ascites, cholecystitis, adenomyomatosis, hypoalbuminemia, congestive heart failure, acute hepatitis

Prolonged fasting, hydrops of the gallbladder (cystic duct obstruction), Courvoisier gallbladder (pancreatic carcinoma), diabetes

Hepatocellular disease, hemolytic disease, surgical jaundice

Destruction of hepatocytes that interfere with the excretion of bilirubin (hepatitis, cirrhosis)

Hepatocytes cannot conjugate bilirubin fast enough to keep up with an increase in red blood cell destruction, creates an increase in indirect or unconjugated bilirubin (sickle cell adenoma)

Mechanical obstruction of biliary tree, causes increase in direct or conjugated bilirubin (choledocholithiasis, cholangiocarcinoma, pancreatic disease)

Periaortic region should be evaluated for lymphadenopathy

IVC and renal veins evaluated for tumor extension

The liver should be evaluated for metastatic disease, for verifying the malignant nature of GB mass

Need to evaluate liver for metastatic disease, biliary tree and pancreatic duct dilatation, regional lymphadenopathy, portal vein and splenic vein for thrombosis

Function of pancreas to produce insulin. Islets of langerhans are insulin producing cells

Function of pancreas to produce amylase, lipase, carboxypeptidase, trypsin, chymotrypsin. Acinar cells are producing enzymes

Located in the right pelvis within retroperitoneum.

Urinoma, lymphocele, hematoma, abscess

Dilated and echo-filled renal vein, absence of intrarenal venous flow, an enlarged kidney, hypoechoic renal parenchyma, highly resistive renal artery waveform

Posterior to IVC displacing it anteriorly

Anechoic or hypoechoic masses without acoustic enhancement

Anterior to the IVC

Inferior to the portal vein

Medial to second portion of the duodenum

Posterior to SMV

Superior anteromedial to the kidney

Posterior to the IVC

Anterior to the crus of diaphragm

Posterior to the tail of pancreas

Anterior to the crus of the diaphragm

Most common primary liver tumor in children

Most common neonatal abdominal mass

Most common solid abdominal mass in children

Is second most common solid mass in children

Most common form of cystic disease in infants

Posterior to the IVC

Posterior to head of pancreas

Seen in nuclear medicine thyroid scintigraphy, indicating hypofunctioning area

Adenomas, commonly appear as hypofunctioning or cold thyroid nodules on a nuclear medicine thyroid scintigram

Precipitation of particulate material in GB, high concentration of calcium carbonate, calcium phosphate, calcium bilirubinate

Chronic cholecystitis due to gallstones or obstruction of cystic duct

Familial, autosomal dominant, adenomatous hyperplasia

Parathyroid adenoma, medullary thyroid carcinoma, pancreatic islet cell tumor, pheochromocytoma

Conjugated bilirubin, alkaline phosphate, gamma glutamyl transpeptidase

Alpha-fetoprotein, carcinoembryonic antigen(CEA)

Inflammatory bowel

Echinococcal cysts

Intrahepatic duct dilatation

Duodenal atresia

Hypertrophic pyloric stenosis

Adenomyomatosis, emphysematous cholecystitis, Pneumobilia

Hepatic Lipoma, angiomyolipomas, adrenal myelolipoma (common denominator = fatty tumors)