[SUBJECT]
ULTRASOUND  You don't measure the left lobe unless abnormal
 One of the most requested imaging modality
 Different probes are used depending on what part of the
body is studying:
o Curve probe -for deep seated organs
o Linear probe - for organs near the skin surface
o Endocavitary probe – used for transvaginal and
transrectal imaging
o Cranial probe - for cranial ultrasound imaging
 Preparation before undergoing an ultrasound procedure:
o NPO at least 4 hrs prior to sched (esp in
gallbladder studies to keep the lumen open, since
gb contracts when with food)
o Give the patient water (at least 100ml) if urinary
bladder is included in the examination
o Ultrasound gel is used to prevent any presence of
air in b/w the skin and the probe
 Correct way of positioning the probe:
o Parasagittal – long axis
o Transverse – short axis
 ORGANS being studied in abdominal UTZ:
o Liver (Left and Right lobes)
o Gallbladder
o Pancreas
o Spleen
o Common Bile Duct
o Aorta
o Urinary Bladder
o Prostate (can be included but is usually a
separate study)
When we request for abdomen ultrasound, we
indicate which part of the abdomen is being studied.
Either UPPER (does not include the pelvis) or
LOWER (pelvic study). The physician may also opt
for WHOLE ABDOMEN
 Only CT Scan, Ultrasound and MRI can do cross-sectional
studies
PANCREAS
 Put probe over the epigastric region, just below the
sternum
 Marker to locate the pancreas is the SPLENIC VEIN
 Looks like a sad emoji 
 You don’t measure the pancreas unless abnormal
 1 view only - transverse view
LEFT LOBE OF LIVER
 Probe position same as pancreas
 Note that the end/tail of the left lobe should look like sharp
end triangle (normal)
o If blunted or not sharp looking, most likely
enlarged and may indicate hepatomegaly
 2 views- parasagittal and transverse
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RIGHT LOBE OF LIVER
 Probe should be position in the RUQ in the subcostal area
(just below the rib)
 2 views - parasagittal and transverse
 Measured in 2 dimensions
o span of the liver and;
o craniocaudal
 15 cm - normal (upper limit)
GALLBLADDER
 Position on RUQ near to the midline
 2 views – parasagittal and transverse
 Normal limits:
o Long axis is 6 cm (parasagittal view)
o Normal limit in transverse view is 4 cm
o Gallbladder wall - 4mm
COMMON BILE DUCT
 CBD is formed by the hepatic and cystic duct
 4 mm is normal measurement
o But can be up to 7 mm in elderly and post-
surgery (chole-) due to dilation
KIDNEYS
 Probe is placed over the right and left flanks
 2 views - parasagittal and transverse
 Normal measurements in adults
o 9 to 12 cm normal (parasagittal)
o 5 to 6 cm (transverse)
 Cortex upper limit is up to 1.5 cm
 Normally, the Left kidney is higher and is larger compared
to the right
- 1 cm - is the allowed difference between
right and left kidney
- Pag matangkad ka, mahaba kidney mo
- Sa bata, kung ano age mo, yun ang size
ng kidney mo in approximation
SPLEEN
 Probe is placed over the Left flank just above the left
kidney
 Window that is used to see the spleen is the LEFT
KIDNEY
 12 cm - normal span
 2 views - parasagittal and transverse
ABDOMINAL AORTA
 Position of the probe is only parasagittal
 Look for stenosis or plaques
 One of the easiest to locate since it is big and pulsating
URINARY BLADDER
 Lower abdomen/ pelvic area - puson
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 2 views - parasagittal and transverse

 Fluid-filled prior to examination to see the bladder wall
when expanded/distended (100 ml)
o Prevoid - bladder is fluid filled, measured in
volume in 3 dimensions (2 transverse, 1
parasagittal)
o Postvoid - after urination, measured (3
dimensions as well)
 Urinary retention
o Reason for checking prevoid and postvoid
measurement
o when fluid volume is >30% of the original volume

PROSTATE
 If bladder is collapsed, prostate cannot be seen
 Window/Landmark for prostate is URINARY BLADDER
 Measured by volume in 3 dimensions
 Normal volume of 30 CC
 >30CC = BPH

CT SCAN OF ABDOMEN
 Includes the base of the lungs down to the pelvis
 Take note of this organs and how they look under the CT
SCAN:
o Pancreas- feathery in appearance
o Left lobe liver – sharp, triangular shape
o Large bowel – with gas with fecal materials
(mottled appearance)
o Small bowel – without gas
o Adrenal glands – looks like a letter Y or has limbs

Lifted from Learning Radiology, Chapter 14:

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BODY CASES
CHOLELITHIASIS
 Blurry region - is called fat stranding, it is a sign of
Case 5. 44y/o, F, right upper quadrant pain radiating to the
inflammation/infection
back
 Most consistent findings are enlarged appendix and blurry
region
 Most common cause is Fecalith and small particles
 Appendix is attached in the cecum area

Hindi totoo yun naglaro kayo after kumain

magkakaappedicitis ka

LIVER CIRRHOSIS

Case 3. 60 y/o, M, Jaundice, pruritus, loss of appetite

 UTZ is the initial modality for gallstones

 Risk factors – Remember F5 (female, forty, fat, fertile, fair
– most common in Caucasians)

ACUTE APPENDICITIS

Case 8. Right lower quadrant pain, vomiting and fever

 Presence of ascites, corrugated wall, smaller size

 Heterogeneous appearance

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FATTY LIVER DISEASE

Case 4. 41 y/o, Male, obese

 (long white arrow) Transition zone – point of obstruction

BENIGN PROSTATE HYPERPLASIA

Case 10: 65 y/o M, frequent or urgent need to urinate and

dribbling at the end of urination

 In UTZ- look for color of kidney, should be the same (if not
expect fatty liver)
 CT- hypodense
 UTZ- hyperechoic compared to kidney
 HU of fat- should be negative (normal: 50-100)

SMALL BOWEL OBSTRUCTION (SBO)

Case 9. 34y/o, F, crampy abdominal pain and vomiting

 There is encroachment at the base/floor of the urinary

bladder
 Normal volume- 30 cc
 Humps on base of urinary bladder - sign of an enlarged
prostate

 Dilation, presence of intestinal lines (valvulae

conniventes), centrally located intestines
 Post op adhesion – most common cause

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COLON CANCER

Case 2. 65 y/o, M, blood in stools, significant weight loss

 Increase size of paracholic gutter, centrally located

intestines, increase opacity

NEPHROLITHIASIS

Case 6: 33 y/o, male, left flank pain

 Apple core deformity is caused by a colonic mass

ASCITES

Case 1. 48 y/o, M, Shortness of breath and increase in

abdominal girth

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 KUB xray - meaning kidney ureters, bladder, with or

without diaphragm
 Abdominal xray - with diaphragm
 If psoas muscle is blurred it may indicate presence of
abscess

 Dilated renal calyces- due to obstruction distally (ureters)

 Request CT- better imaging for detection of stone in ureter
 Don’t use contrast in CT because the stone will not be
seen, and contrast fluid will not flow due to the obstruction

OTHER READING MATERIALS

 Learning Radiology, Chapter 14: Recognizing the Normal
Abdomen and Pelvis on Computed Tomography
 http://learningradiology.com/lectures/gilectures/plainabdo
men2012/Plain%20Films%20of%20the
%20Abdomen/Plain%20Films%20of%20the
URETEROLITHIASIS WITH HYDRONEPHROSIS %20Abdomen.html
 http://www.dartmouth.edu/~anatomy/HAE/Abdomen/ab_in
Case 7. 47 y/o, M, right flank pain and hematuria dex.html

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