abdo, smp, msk, vasc routine exams anatomy

Sirpa FalkMCR EMEA BL USDecember 29, 2011

Routine examsAbdomen, Small parts, Msk & Vascular

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Introduction to UltrasoundAbdominal Imaging - Anatomy

• The abdominal exam generally includes the examination of the following:

– Liver– Gallbladder– Right and Left Kidneys– Spleen– Pancreas– Aorta– IVC (inferior vena cava)

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Philips C5-1

• C5-1 / C9-4

– Wide far-field of view

– Wider near field than phased

– Supports multiple modalities

• S5-1

– When greater penetration is needed

Philips C9-4

Introduction to UltrasoundAbdominal Imaging – Transducers

Philips S5-1

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Introduction to UltrasoundAbdominal Imaging - Anatomy

• Liver

– Located inferior to the right 7th and 11th ribs

– Changes position with inspiration

Right Lobe

Left Lobe

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• Diffuse liver disease

–Cirrhosis (a condition in which the liver becomes scarred and fibrous, thus reducing its ability to function

–Fatty Liver disease

–In the United States, chronic alcoholism and hepatitis C are the most common causes.

Introduction to UltrasoundAbdominal Imaging - Anatomy

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Introduction to UltrasoundAbdominal Imaging - Anatomy

• Liver transplant evaluations

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• Liver Disease:

– Benign and malignant neoplasms

– Metastatic disease

– Liver abscess

Introduction to UltrasoundAbdominal Imaging - Anatomy

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Liver: Normal and abnormal blood flow.

• Portal Veins– Shows a monophasic flow pattern– Flows continuously in to the liver– Direction of flow is termed hepatopedal– With traditional color flow orientation, it should be encoded red

• Hepatic vein– Traditional color flow orientation is encoded blue

• Hepatic artery– Might be mistaken for the CBD

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• Liver Vasculature

– Hepatic veins

– Hepatic artery

– Portal Vein

Portal Vein

Introduction to UltrasoundAbdominal Imaging - Anatomy

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• Gallbladder and Bile Ducts

– Most common reason for gallbladder disease is gallstones

– Gallstones are solid stones formed in the gall bladder from cholesterol and bile salts

Introduction to UltrasoundAbdominal Imaging - Anatomy

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• Kidneys

Introduction to UltrasoundAbdominal Imaging - Anatomy

Long axis or sagittal view

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Transverse view

Introduction to UltrasoundAbdominal Imaging - Anatomy

• Kidneys

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Philips HD11 XE Ultrasound System

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Introduction to UltrasoundAbdominal Imaging - Anatomy

• Pancreas

– Pancreatitis

– Pancreatic carcinoma

– Pseudocysts

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Spleen: Physiology

• Large mass of lymphatic tissue• Not essential for life• Filters

– Blood– From Antibodies

• Breakdown hemoglobin• Reservoir for blood• Blood formation for fetuses and severe anemia.

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CHaSpa

Ca

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Introduction to UltrasoundSmall Parts Overview

• Imaging of:

– breasts, thyroid and testicles

• Performed to:– Assess lumps or other abnormalities– Guide interventional procedures

• Use linear transducer– High frequency– Increased resolution

Philips L12-5

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Introduction to UltrasoundSmall Parts Overview - Thyroid Scanning Demonstration

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Introduction to UltrasoundSmall Parts Overview

• Which transducer?• linear transducer

• Why?– High frequency– Increased resolution

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Introduction to UltrasoundSmall Parts Overview – Thyroid Anatomy

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An ultrasound of the thyroid is typically used to help diagnose:

･ a lump in the thyroid (Goiter, benign or malignant mass/nodule )

･ a thyroid that is not functioning properly

Introduction to UltrasoundSmall Parts Overview – Thyroid Imaging

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Ilium

Osseous Acetabular

IschiumTriradiateCartilage

Echogenic Labrum

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First

Second

Third

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Philips HD11 XE Ultrasound System

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Introduction to UltrasoundVascular Overview

• Provides imaging of the body's veins and arteries.

• Useful in evaluating the body's circulatory system

• Vascular ultrasound is performed to:

– assess blood flow to organs and tissues

– identify blockages (stenosis) and other abnormalities like blood clots,

plaque or emboli

– determine whether a patient is a good candidate for a procedure

such as angioplasty

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Introduction to UltrasoundVascular Overview -Anatomy

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Introduction to UltrasoundVascular Overview – Carotid

• Carotid Artery

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• Carotid Arteries:

– Assess patients with stroke, dizziness

– Flow patterns in the vessels (shape, speed & direction)

– Blood clot, dissection, narrowing of vessels, plaque

– Assess intima-media vessel layer thickness, an indicator of

cardiovascular disease

Introduction to UltrasoundVascular Overview - Carotid

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Introduction to UltrasoundVascular Overview – Carotid

Philips L9-3 (work-horse vascular transducer)

Which Transducer?Linear transducer (L9-3, L11-3

or similar)Why?

High FrequencyBetter detail resolutionLinear beam ideal for imaging

tubes

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• Which Transducer?– Sector transducer (S5-1 or similar)

• Why?– Good access to scanning windows available– Good frequency range for penetration

Introduction to UltrasoundVascular Overview - TCD

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TranstemporalWindow

Transoccipital/SuboccipitalWindow

TransorbitalWindow

Introduction to UltrasoundVascular Overview – TCD windows

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Introduction to UltrasoundVascular Overview - TCD

Global Training and Education Internal and Confidential30

Trans-cranial Artery Anatomy

MCA

ACA

VERTEBRAL

BASILAR

PCA

PCoA

ACoA

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• What are we looking for?– Flow patterns in the

vessels– Shape, speed and

direction of flow– Assessing patients with

strokes and cerebral bleeding

Introduction to UltrasoundVascular Overview - TCD