Ecografia 2

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2011 14:08:30
Standard Planes for Abdominal Scanning … p. 2
Upper abdominal longitudinal scan, center
Lower abdominal longitudinal scan, center … p. 2/3
Upper abdominal longitudinal scan, right side
Upper abdominal longitudinal scan, left side … p. 4/5
Upper abdominal transverse scan, center
Lower abdominal transverse scan, center … p. 6/7
Upper abdominal transverse scan, right side
Upper abdominal transverse scan, left side … p. 8/9
Longitudinal flank scan, right side
Longitudinal flank scan, left side … p. 10/11
Transverse flank scan, right side
Transverse flank scan, left side … p. 12/13
Note: The number key for the diagrams is on the fold-out flap
inside the back cover.
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2
Scanning Planes
Upper abdominal longitudinal scan, center
Lower abdominal longitudinal scan, center
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Standard Planes for Abdominal Scanning 3
40 73
20
5 7
1
80
85
89
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4
Scanning Planes
Upper abdominal longitudinal scan, right side
Upper abdominal longitudinal scan, left side
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30
20 76
60
21
40
70
61
50
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6
Scanning Planes
Upper abdominal transverse scan, center
Lower abdominal transverse scan, center
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70
20 40
10 1
50
90
60 61
80
97 97
85
89
97
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8
Scanning Planes
Upper abdominal transverse scan, right side
Upper abdominal transverse scan, left side
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21
40 7 70
10 1
19
20 50
90
60 61
19 70
7
10 1
20 50
90
60 61
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10
Scanning Planes
Longitudinal flank scan, right side
Longitudinal flank scan, left side
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20
60
21
70
61
50
50
61
20
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12
Scanning Planes
Transverse flank scan, right side
Transverse flank scan, left side
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20
60
10 21
90 19
1
7
40
61 70
50
50
70
61
40
7 1
90
60
20
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Aorta and Vena Cava in Suprarenal Transverse Sections,
Including the Renal Vessels … p. 16
1 Passage of aorta and vena cava through diaphragm
2 Left gastric artery
3 Celiac trunk
4 Celiac trunk
5 Hepatic artery
6 Splenic artery
7 Superior mesenteric artery
9 Superior mesenteric artery and splenic vein
10 Left renal vein and right renal artery
Aorta and Vena Cava in Infrarenal Transverse

Sections … p. 26
11 Infrarenal aorta and vena cava
14 Infrarenal aorta, vena cava,
superior mesenteric artery and vein
16 Aortic bifurcation
17 Iliac arteries
18 Confluence of iliac veins
19 Iliac vessels
20 Iliac vessels
21 Iliac vessels
22 Iliac vessels
23 Left iliac vessels
Splenic Artery and Vein in Longitudinal Sections … p. 40

25 Aorta
26 Splenic vein and left gastric artery
27 Splenic artery and vein, celiac trunk
29 Splenic artery and vein, renal artery and vein
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Hepatic Artery in Longitudinal Sections … p. 46
31 Celiac trunk
32 Hepatic artery and splenic vein
33 Hepatic artery and superior mesenteric vein
34 Hepatic artery and portal vein
Renal Artery and Vein in Longitudinal Sections … p. 50

35 Aorta
36 Right renal artery and left renal vein
37 Vena cava and right renal artery
38 Right renal artery and right renal vein
Right Renal Artery and Vein in Transverse Sections … p. 54

39 Opening of renal vein
40 Renal vein
41 Renal vein at hilum, renal artery
42 Renal artery
Left Renal Artery and Vein in Longitudinal Sections … p. 58

43 Vena cava
45 Aorta and left renal vein
46 Left renal vessels, splenic artery and vein
Vessels of the Porta Hepatis in Longitudinal Sections … p. 62

47 Portal vein, vena cava, right renal artery
48 Portal vein, vena cava, right renal artery, and bile duct
49 Portal vein, vena cava, and bile duct
50 Portal vein and hepatic artery
51 Hepatic artery, superior mesenteric vein
52 Hepatic artery, superior mesenteric artery, and splenic vein
Vessels of the Porta Hepatis in Transverse Sections … p. 68

53 Hepatic artery, portal vein, vena cava
54 Hepatic artery, bile duct, portal vein
55 Bile duct, gallbladder, vena cava
56 Bile duct, gallbladder, superior mesenteric vein
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16
1 Vessels
1 Passage of aorta and vena cava through diaphragm
2 Left gastric artery
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Aorta and Vena Cava in Suprarenal Transverse Sections, Incl. the Renal Vessels 17
24
21
70
23
10 1
96
20
90
Just below the diaphragm, the vena cava is surrounded by

liver tissue. The aorta lies directly behind the gastroesophageal
junction, often making the vessel more difficult to scan.
24
21
96 6
23
1
10
20
90
The left gastric artery is identified as a

small-caliber vessel cranial to the celiac trunk.
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18
1 Vessels
3 Celiac trunk
4 Celiac trunk
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24
21
22
70
6 43
17
96 3
1
10
20
90
After arising from the aorta, the celiac trunk

runs a short distance to the left.
21
22
3 43 70
17
10
1 18
96
20
90
The proximal part of the celiac trunk

also turns slightly downward in most cases.
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20
1 Vessels
5 Hepatic artery
6 Splenic artery
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21
22 4 43
3
17
1 18
10 96
20
90
The celiac trunk runs slightly to the right,

giving rise to the hepatic artery.
21
22
4 3 5
43
17
1
10 96
18
20
90
The splenic artery branches from

the celiac trunk at a right angle.
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22
1 Vessels
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21
5
22 4
18 7
17
43
1
96 18
10
20
90 61
The superior mesenteric artery arises just below

the celiac trunk and runs parallel to the aorta.
21
43
22 7
4
18 18
1
36 96
10
20
90 61
The root of the superior mesenteric artery

is usually surrounded by an echodense fat pad.
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24
1 Vessels
9 Superior mesenteric artery and splenic vein
10 Left renal vein and right renal artery
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21 43
42 7
18
15
8 1
36
10
20 9
90 61
The aorta, the superior mesenteric artery, and the splenic vein
crossing over the superior mesenteric artery provide landmarks
for identifying the head of the pancreas.
21 43
42 7
76 18
8 1 15
20 36 10
90
The left renal vein is physiologically compressed

between the aorta and the superior mesenteric artery.
It is slightly congested proximal to the compression site.
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26
1 Vessels
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Aorta and Vena Cava in Infrarenal Transverse Sections 27
21
43
18 7
41 15
76 1
8
36
10
94
90
The vena cava is easily compressible with the transducer,

and it bears impressions from adjacent organs.
70
21 42
7
41 19
1
94 94
36
10
90
The aorta has a circular cross section,

whereas the vena cava is somewhat flattened.
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28
1 Vessels
14 Infrarenal aorta, vena cava, and superior mesenteric

artery and vein
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21
70
76
19 7
41
1
94 10
94
90
The caliber of the vena cava varies with the pulse and
respirations. The diameter of the aorta measures 2.5 cm
in its cranial portion, 2.0 cm in its caudal portion.
19 7
1
10
90
Together with the aorta and vena cava, the superior

mesenteric artery and vein form a typical four-vessel pattern
in a low transverse scan through the upper abdomen.
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30
1 Vessels
16 Aortic bifurcation
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1
10
90
While the aorta and vena cava are relatively far apart
in the upper abdomen, they converge at the level
of the promontory, coming very close together.
2
10 2
90
94
The aorta divides into the common iliac arteries at the

level of the L4 vertebral body, above the promontory.
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32
1 Vessels
17 Iliac arteries
18 Confluence of iliac veins
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2
2
10
90
94
The aortic bifurcation is located slightly

above the confluence of the iliac veins.
2
16
16 2
90
94
The confluence of the iliac veins lies

approximately at the level of the umbilicus.
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34
1 Vessels
19 Iliac vessels
20 Iliac vessels
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2
16 2
16
90
The iliac arteries are first anterior

and then lateral to the iliac veins.
2
16 16 2
90
The iliac vessels follow the concavity

of the lesser pelvis to the femoral arteries.
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36
1 Vessels
21 Iliac vessels
22 Iliac vessels
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16 2
16
90
In serial transverse scans down the iliac vessels, the sections

of the vessels are seen to move laterally and posteriorly.
16 2
16
90
The iliac vessels are more difficult to scan

at lower levels due to intervening bowel gas.
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38
1 Vessels
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2
95
16
97
The iliac veins run dorsomedial to the

iliac arteries in the lesser pelvis.
80 2
77
16 95
97
The iliac veins are always medial to the

arteries at the level of the inguinal ligament.
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40
1 Vessels
25 Aorta
26 Splenic artery and left gastric artery
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Splenic Artery and Vein in Longitudinal Sections 41
40
18
21
4 15
96
90
Because the celiac trunk runs slightly to the left initially, often it is
not displayed in a longitudinal scan centered over the aorta.
40
18
7
21 5 15
6
96
1
90
The left gastric artery runs cranially between the common

hepatic artery and splenic artery. It is often difficult to define.
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42
1 Vessels
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40
18
5
21 6 15
7
96
1
90
The celiac trunk divides into the left gastric artery,

common hepatic artery, and splenic artery.
40
21 5 18
6 15
3 9
96
The curved course of the celiac trunk and splenic artery

explains why both vessels appear in the same sagittal section.
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44
1 Vessels
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43
21 5
18
15
6
9
96
74
The splenic artery turns left and runs posteriorly

with the splenic vein to the hilum of the spleen.
21
5 43
18
15
70
9
Longitudinal scan on the left side shows the typical appearance of the
large splenic and renal veins and the smaller splenic and renal arteries.
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46
1 Vessels
31 Celiac trunk
32 Hepatic artery and splenic vein
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Hepatic Artery in Longitudinal Sections 47
70
40
18
20
7
3
The origin of the celiac trunk and its division

into branches are subject to numerous variations.
70
40
18
4
1
20
The hepatic artery turns upward and to the right and runs
along the inferior border of the liver toward the porta hepatis.
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48
1 Vessels
33 Hepatic artery and superior mesenteric vein
34 Hepatic artery and portal vein
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Hepatic Artery in Longitudinal Sections 49
70
40
19
15
20 4
8
90
A longitudinal scan between the aorta and vena cava

typically displays sections of four vessels: the hepatic artery,
venous confluence, left renal vein, and right renal artery.
41
4
17
20
10 8
96
A longitudinal scan over the vena cava displays

four typical vascular sections: the vena cava,
portal vein, hepatic artery, and renal artery.
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50
1 Vessels
35 Aorta
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Renal Artery and Vein in Longitudinal Sections 51
40
21 7
18
5 15
3
The left renal vein runs between the aorta and superior
mesenteric artery, where it is subject to physiologic compression.
21
24
19
17
15
17 8
90
The section of the right renal artery can be identified between the
aorta and vena cava. Just above the renal artery are the left renal vein
and a longitudinal section of the superior mesenteric vein.
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52
1 Vessels
37 Vena cava and right renal artery
38 Right renal artery and right renal vein
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Renal Artery and Vein in Longitudinal Sections 53
20
17
10 8
The right renal artery usually impresses the posterior

surface of the vena cava, although variants may occur.
20
30
8 14
17
92 8
The renal veins are often more than twice

the diameter of the renal arteries.
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54
1 Vessels
39 Opening of renal vein
40 Renal vein
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Right Renal Artery and Vein in Transverse Sections 55
20
76
30
1
10
14
90
69
95
The opening of the right renal vein at the vena cava

can be clearly defined above the kidney in most subjects.
20 30
76
10
14 1
60
90
95
In serial transverse scans down the vena cava,

the oval cross section of the renal vein separates from
the vena cava and moves laterally toward the kidney.
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56
1 Vessels
41 Renal vein at hilum, renal artery
42 Renal artery
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Right Renal Artery and Vein in Transverse Sections 57
20 30
76
10
14 1
8
60
95 90
The renal artery follows the same course as the

renal vein, but at a slightly more caudal level.
20
30
76
10
8 1
60
95 90
The renal arteries are located posterior

and caudal to the renal veins.
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58
1 Vessels
43 Vena cava
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Left Renal Artery and Vein in Longitudinal Sections 59
21
4 40
17 17
8
10
90
90
The right renal artery passes behind the

vena cava, impressing its posterior surface.
40
19
21 18
4 15
8
96
90
The scan plane cuts the left renal vein and right
renal artery between the aorta and vena cava.
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60
1 Vessels
45 Aorta and left renal vein
46 Left renal vessels, splenic artery and vein
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Left Renal Artery and Vein in Longitudinal Sections 61
18
21 40 7
15
5
90
The left renal vein runs between the aorta

and superior mesenteric artery.
21
40 18
5 15
9
The left renal vessels are often difficult

to scan because of overlying air.
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62
1 Vessels
47 Portal vein, vena cava, right renal artery
48 Portal vein, vena cava, right renal artery, and bile duct
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Vessels of the Porta Hepatis in Longitudinal Sections 63
40
20
36
4
12 17 10
8
The triad of the portal vein, vena cava,

and right renal artery provides a typical landmark
in the upper abdominal longitudinal scan.
20 40
36
12 17 10
8
When the triad of the portal vein, vena cava,

and right renal artery is identified, the scan will usually
include a longitudinal section of the bile duct.
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64
1 Vessels
49 Portal vein, vena cava, and bile duct
50 Portal vein and hepatic artery
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20 40
36
12
4
17
10
The bile duct enters the head of the

pancreas anterior to the vena cava.
45
20 40
4
17
10
The portal vein and hepatic artery run side-by-side

posterior to the head of the pancreas.
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66
1 Vessels
51 Hepatic artery, superior mesenteric vein
52 Hepatic artery, superior mesenteric artery,

and splenic vein
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70
40 19
4 15
20 45
When the mesenteric vein is viewed in longitudinal section,

typically the scan will also display the hepatic artery cranially
and the right renal artery and left renal vein posteriorly.
70
40
18 7
20 15
4
When the superior mesenteric artery is viewed in

longitudinal section, typically the scan will also show
the hepatic artery, splenic vein, and left renal vein.
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68
1 Vessels
53 Hepatic artery, portal vein, vena cava
54 Hepatic artery, bile duct, portal vein
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Vessels of the Porta Hepatis in Transverse Sections 69
24 21
20
12
3
17 4
36
1
17 96
10
90
The portal vein runs between the vena cava

and hepatic artery.
21
20 24
36 4 3
17
1
10 96
90
The hepatic artery runs cephalad into

the porta hepatis.
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70
1 Vessels
55 Bile duct, gallbladder, vena cava
56 Bile duct, gallbladder, superior mesenteric vein
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Vessels of the Porta Hepatis in Transverse Sections 71
22 21
24
20
40
30 70
36 18
10
96 1
90
The bile duct is identified medial to the

gallbladder and anterior to the vena cava.
21
24
22
40
7
30 36 19
1
10 96
20
90
The bile duct runs parallel to the superior mesenteric vein for a
short distance, then turns laterally to the right toward the papilla.
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Liver in Longitudinal Sections … p. 74
57 Left lobe of liver, lateral segment, subsegments II
and III
58 Left lobe of liver, ligamentum teres, boundary
between lateral and medial segments
59 Left lobe of liver, ligamentum teres, boundary
between lateral and medial segments
60 Left hepatic vein, ligamentum teres, boundary
between lateral and medial segments, caudate lobe
64 Medial segment, subsegment IV, quadrate lobe
65 Gallbladder, portal vein, vena cava, boundary
between medial and anterior segments
66 Middle hepatic vein, boundary
between medial and anterior segments
67 Anterior segment, subsegments VIII and V
68 Right hepatic vein, boundary
between anterior and posterior segments
69 Posterior segment, subsegments VII and VI
70 Posterior segment, lateral portions of liver, kidney
Left Portions of the Liver in Transverse Sections … p. 88

71 Left lobe of liver, lateral segment, heart
73 Left lobe of liver, lateral segment, hepatic veins
74 Left lobe of liver, lateral segment, caudate lobe
76 Left lobe of liver, lateral segment,
left portal vein branch
77 Left lobe of liver, lateral segment, ligamentum teres
78 Left lobe of liver, subsegment III, ligamentum teres
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Central Portions of the Liver in Transverse Sections … p. 96
79 Medial and anterior hepatic segments,
opening of hepatic veins
81 Medial and anterior hepatic segments, hepatic veins,
caudate lobe
82 Medial and anterior hepatic segments, hepatic veins,
caudate lobe
83 Medial and anterior hepatic segments, caudate lobe
left portal vein branch, caudate lobe
bifurcation of portal vein
right portal vein branch
right and left portal vein branches
quadrate lobe, ligamentum teres, portal vein
93 Medial and anterior hepatic segments, quadrate lobe,
ligamentum teres, portal vein
ligamentum teres, gallbladder
ligamentum teres, gallbladder
96 Inferior border of liver, kidney, gallbladder,
ligamentum teres
Right Portions of the Liver in Transverse Sections … p. 114

97 Posterior segment, upper subsegment
98 Posterior segment, portal vein
99 Posterior segment, caudal subsegment, kidney
100 Posterior segment, inferior border
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74
2 Liver
57 Left lobe of liver, lateral segment, subsegments II and III
58 Left lobe of liver, ligamentum teres, boundary between

lateral and medial segments
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Liver in Longitudinal Sections 75
II III
21, 26
70
94
18
43
The liver is divided into a left and a right lobe on anatomical criteria.
The left lobe corresponds to the lateral segment; the right lobe
consists of the medial, anterior, and posterior segments.
III
II
21 73
98
93, 94
42 45
74 18
On functional criteria, the lateral and medial segments

belong to the left lobe of the liver while the anterior and
posterior segments belong to the right lobe.
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76
2 Liver
59 Left lobe of liver, ligamentum teres, boundary between

lateral and medial segments
60 Left hepatic vein, ligamentum teres, boundary between

lateral and medial segments, caudate lobe
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II
21 III 73
42
98 5
15 18
3 7
74
1
90
The lateral segment is composed of subsegment II

cranially and subsegment III caudally.
III
II
21
24 93
70
25
11
92
93
23 I 92
17
10
96
The boundary between the lateral and medial segments,

i.e., between the anatomical left and right lobes
of the liver, is the left hepatic vein.
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78
2 Liver


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IV 21 24
17
11 4
41
17
25
23 I
10
90
The caudate lobe corresponds to subsegment I of the medial

segment and is located lateral and anterior to the vena cava.
Most of the medial segment consists of subsegment IV.
24
20 IV
22
17
11 17
41
23 I
10
90
The boundary between the lateral and medial segments,

i.e., between the anatomical left and right lobes
of the liver, is the ligamentum teres.
Block_engl_02.indd 79 25.08.2011 14:09:41

80
2 Liver

64 Medial segment, subsegment IV, quadrate lobe
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24
IV
17
41
17
10
90
Ligamentum teres (the obliterated umbilical vein) extends from the

left portal vein branch to the anterior inferior border of the liver.
20
22 IV
17
17
93
96
10
The caudal part of the medial segment, the quadrate lobe,

is situated between ligamentum teres and the gallbladder.
The quadrate lobe is part of subsegment IV.
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82
2 Liver
65 Gallbladder, portal vein, vena cava, boundary between

medial and anterior segments
66 Middle hepatic vein, boundary between

medial and anterior segments
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27
22 IV
30
17
10 93
94
The plane of the gallbladder and vena cava forms the boundary
plane between the medial and anterior segments of the liver.
20
12
17
10
10
14
The middle hepatic vein marks the boundary between the

medial and anterior segments in the cranial part of the liver.
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84
2 Liver
67 Anterior segment, subsegments VIII and V
68 Right hepatic vein, boundary between

anterior and posterior segments
Block_engl_02.indd 84 25.08.2011 14:09:42

28
VIII V
12
17
96 14
78
The anterior segment consists of subsegment VIII

cranially and subsegment V caudally.
12
17
13
96
The right hepatic vein and the division of the right portal vein branch
mark the boundary plane between the anterior and posterior segments.
Block_engl_02.indd 85 25.08.2011 14:09:42

86
2 Liver
69 Posterior segment, subsegments VII and VI
70 Posterior segment, lateral portions of liver, kidney
Block_engl_02.indd 86 25.08.2011 14:09:42

VII 29
VI
96
The posterior segment consists of subsegment VII

cranially and subsegment VI caudally.
17 29 VI
VII
60
65
The right lobe of the liver is highly variable

in its caudal extent.
Block_engl_02.indd 87 25.08.2011 14:09:42

88
2 Liver
Block_engl_02.indd 88 25.08.2011 14:09:42

Left Portions of the Liver in Transverse Sections 89
26 II
96
98
The left lobe of the liver is in close proximity to the heart,

separated from it only by the diaphragm.
26 II
96
97
The anatomical left lobe of the liver

corresponds to the lateral hepatic segment.
Block_engl_02.indd 89 25.08.2011 14:09:43

90
2 Liver
73 Left lobe of liver, lateral segment, hepatic veins
Block_engl_02.indd 90 25.08.2011 14:09:43

27 IV
28 VIII
26 II
12 11
13
23 25
29
I 71
VII 10
96
The left hepatic vein marks the boundary between

the lateral and medial hepatic segments.
27 IV
26 II
12 11
28 VIII 25
23
I 71
10 93
94
The cranial part of the lateral hepatic segment

is designated as subsegment II.
Block_engl_02.indd 91 25.08.2011 14:09:43

92
2 Liver
76 Left lobe of liver, lateral segment, left portal vein branch
Block_engl_02.indd 92 25.08.2011 14:09:43

27 IV 26 II
11
11
12
28 VIII 17 71
23 I
74 94
10
93
1
96
The caudate lobe is considered a separate

entity, designated as subsegment I.
27 IV 26 II
17
72
4
93,94
17
43
15
10 18
1
96
In scanning down the left lobe of the liver, the left

branch of the portal vein marks the boundary between
the cranial and caudal subsegments of the lobe.
Block_engl_02.indd 93 25.08.2011 14:09:43

94
2 Liver
77 Left lobe of liver, lateral segment, ligamentum teres
78 Left lobe of liver, subsegment III, ligamentum teres
Block_engl_02.indd 94 25.08.2011 14:09:43

26 II
27, 22
IV
24 72
17 45
4 42 93
18
17 94
7 43
10
96
1 15
Ligamentum teres arises directly from the left

portal vein branch and runs forward and downward.
26 III
24
27, 22 70
IV 15
93, 94
10
1
Ligamentum teres presents a triangular or polygonal shape

in cross section. It marks the boundary between subsegment III
and the quadrate lobe, which is designated as subsegment IVb.
Block_engl_02.indd 95 25.08.2011 14:09:44

96
2 Liver


Block_engl_02.indd 96 25.08.2011 14:09:44

Central Portions of the Liver in Transverse Sections 97
VIII
IV II
20 21
10
96
The hepatic veins converge and enter the

vena cava just below the diaphragm.
II
VIII 94
IV
13 12 11
VII 10
96
The opening of the hepatic veins at the vena cava

forms a typical stellate pattern in transverse section.
Block_engl_02.indd 97 25.08.2011 14:09:44

98
2 Liver

hepatic veins, caudate lobe

hepatic veins, caudate lobe
Block_engl_02.indd 98 25.08.2011 14:09:44

VIII II
IV
11
13 25
12
71
23
VII 10 I
96
The upper pole of the caudate lobe extends to a point

just below the opening of the hepatic veins into the vena cava.
IV
VIII II
11
12 25
13
71
23
I
10 93
VII 93
The three hepatic veins define the boundaries between

the lateral, medial, anterior, and posterior segments of the liver.
Block_engl_02.indd 99 25.08.2011 14:09:45

100
2 Liver

caudate lobe

Block_engl_02.indd 100 25.08.2011 14:09:45

VIII IV 11
II
12 25 71
13
23
I 93
10 94
VII
Ligamentum venosum separates the caudate lobe

from subsegment II of the lateral hepatic segment.
VIII IV 11
II
12
17 25
13 23
I 72
10
VII 1
96
90
The caudate lobe of the liver is

designated as subsegment I.
Block_engl_02.indd 101 25.08.2011 14:09:45

102
2 Liver


Block_engl_02.indd 102 25.08.2011 14:09:45

II
IV
VIII
11
12 17
23 I 72
13
10 1
96
VII
90
The caudate lobe is interposed between

the vena cava and left portal vein branch.
II
VIII IV
12 11
17
17
3
10 1
VII 96
90
The upper subsegments of the lateral and medial hepatic segments

are designated as subsegment II and subsegment IVa, respectively.
Block_engl_02.indd 103 25.08.2011 14:09:45

104
2 Liver


Block_engl_02.indd 104 25.08.2011 14:09:46

II
IV
VIII
11
17
12
4
17 7
10 1
96
VII
90
The upper subsegments of the anterior and posterior hepatic

segments are designated as subsegments VIII and VII.
II
IV
VIII
11
17
12
17 4
7 5
43
10 1
VII 96
90
The bifurcation of the portal vein

is located just anterior to the vena cava.
Block_engl_02.indd 105 25.08.2011 14:09:46

106
2 Liver

right portal vein branch

Block_engl_02.indd 106 25.08.2011 14:09:46

IV
VIII
II
17
12 11
17 4
5
7 43
10
1
VII
96
90
The division of the portal vein into right and left branches marks the
approximate boundary between the upper and lower subsegments.
II
VIII
IV 17
4 18
17 7 43
15
10
1
VII
90
The division of the portal vein into right and left branches
shows an antler-like configuration on ultrasound.
Block_engl_02.indd 107 25.08.2011 14:09:46

108
2 Liver


Block_engl_02.indd 108 25.08.2011 14:09:46

II
IV
VIII 17
22
17
7 43
15
10
18
1
VII
90
The right portal vein branch initially runs

slightly caudally from the bifurcation.
22 24
III
V IV
70
18
17
7
43
10 15
9
1
VI
90
Ligamentum teres marks the boundary plane

between the right and left lobes of the liver.
Block_engl_02.indd 109 25.08.2011 14:09:47

110
2 Liver


quadrate lobe, ligamentum teres, gallbladder
Block_engl_02.indd 110 25.08.2011 14:09:47

III
V 24
22
IV
70
18
43
10 7 1
VI
14
90
The lower subsegments of the lateral, medial, anterior,

and posterior hepatic segments are designated,
respectively, subsegments III, IVb, V, and VI.
22
V III
IV
24
30
70
42
VI
76
19
94
14 10 1
The gallbladder and ligamentum teres form the boundary

structures of the quadrate lobe in transverse section.
Block_engl_02.indd 111 25.08.2011 14:09:47

112
2 Liver

quadrate lobe, ligamentum teres, gallbladder
96 Inferior border of liver, kidney, gallbladder,

ligamentum teres
Block_engl_02.indd 112 25.08.2011 14:09:47

24 III
V 22
IV
73
30 42
76
41 19
17
VI
10
1
14
The vena cava–gallbladder plane marks the boundary between

the right and left lobes of the liver based on functional criteria.
III
22 24
V IV
77
30
VI
94
60
The shape of the inferior hepatic border is influenced by the kidney,

the gallbladder, and the groove for ligamentum teres.
Block_engl_02.indd 113 25.08.2011 14:09:48

114
2 Liver
97 Posterior segment, upper subsegment
98 Posterior segment, portal vein
Block_engl_02.indd 114 25.08.2011 14:09:48

Right Portions of the Liver in Transverse Sections 115
VIII, 28
VII, 29
13 12
11
96 10
The upper subsegment of the posterior hepatic

segment is designated as subsegment VII.
20, 29 17 77
10
96
The right portal vein branch marks the approximate boundary

between subsegment VII cranially and subsegment V caudally.
Block_engl_02.indd 115 25.08.2011 14:09:48

116
2 Liver
99 Posterior segment, lower subsegment, kidney
100 Posterior segment, inferior border
Block_engl_02.indd 116 25.08.2011 14:09:48

Right Portions of the Liver in Transverse Sections 117
29
VI
77
14
60 10
The lower subsegment of the posterior hepatic

segment is designated as subsegment VI.
29
VI
77
10
8
60
The right lobe of the liver is highly variable

in its inferior extent.
Block_engl_02.indd 117 25.08.2011 14:09:48

Gallbladder in Upper Abdominal Transverse
Scans from Above Downward … p. 120
101 Right branch of the portal vein, ligamentum venosum
102 Portal vein, ligamentum venosum
103 Neck of the gallbladder
104 Junction of the neck and body of the gallbladder
105 Body of the gallbladder
106 Gallbladder fundus
Gallbladder in Upper Abdominal Longitudinal

Scans from Left to Right … p. 126
107 Vena cava, duodenum, portal vein bifurcation
108 Body of the gallbladder, portal vein bifurcation
109 Gallbladder, portal vein
111 Gallbladder, portal vein, right kidney
112 Gallbladder fundus, right kidney
Gallbladder in Transverse Flank Scans

from Above Downward … p. 132
113 Gallbladder neck, duodenum, right kidney
114 Gallbladder neck, small bowel, right kidney
115 Gallbladder body, small bowel, right kidney
116 Gallbladder fundus, small bowel
Gallbladder in Longitudinal Flank Scans

from Posterior to Anterior … p. 136
117 Right kidney, liver
118 Gallbladder, liver
Block_engl_03.indd 118 25.08.2011 14:10:07

Details of Gallbladder … p. 140
121 Regions of the gallbladder, Heister valves
122 Layered structure of the gallbladder wall
Bile Ducts in Upper Abdominal Transverse

Scans From Above Downward … p. 142
123 Common duct, hepatic artery, splenic vein
125 Common duct, hepatic artery
128 Common duct, head of pancreas
Bile Ducts in Upper Abdominal Longitudinal

Scans from Right to Left … p. 148
129 Common duct, portal vein, hepatic artery
130 Common duct, hepatic artery, portal vein
Block_engl_03.indd 119 25.08.2011 14:10:07

120
3 Gallbladder
101 Right branch of the portal vein, ligamentum venosum
102 Portal vein, ligamentum venosum
Block_engl_03.indd 120 25.08.2011 14:10:07

Gallbladder in Upper Abdominal Transverse Scans from Above Downward 121
20
73
* 4
17
96 10
The interlobar fissure (*) anterior to the right branch of the

portal vein is the key landmark for locating the gallbladder.
20
37
17
76
10 1
The gallbladder neck is located just caudal to the

right portal vein branch and interlobar fissure.
Block_engl_03.indd 121 25.08.2011 14:10:08

122
3 Gallbladder
103 Neck of the gallbladder
104 Junction of the neck and body of the gallbladder
Block_engl_03.indd 122 25.08.2011 14:10:08

33 76
19
20
10
1
The duodenum is located medial

to the neck of the gallbladder.
20
40 19
32 76
10 1
90
The duodenal bulb can be consistently identified on the

free peritoneal side of the body or neck of the gallbladder.
Block_engl_03.indd 123 25.08.2011 14:10:08

124
3 Gallbladder
105 Body of the gallbladder
106 Gallbladder fundus
Block_engl_03.indd 124 25.08.2011 14:10:08

20 32
92
76 10
60
The duodenum passes between the body

of the gallbladder and the vena cava.
93
20 31
60
The gallbladder fundus may extend almost to the anterior wall

of the trunk, or it may be situated very deeply behind the liver.
Block_engl_03.indd 125 25.08.2011 14:10:09

126
3 Gallbladder
107 Vena cava, duodenum, portal vein bifurcation
108 Body of the gallbladder, portal vein bifurcation
Block_engl_03.indd 126 25.08.2011 14:10:09

Gallbladder in Upper Abdominal Longitudinal Scans from Left to Right 127
20
73
17
17 76
10
The vena cava, the portal vein bifurcation, and the echogenic
band of the interlobar fissure are the principal landmarks for
locating the gallbladder in longitudinal scans.
20
17
30
17 76
10
The duodenum is located posterior to the

gallbladder and caudal to the right colic flexure.
Block_engl_03.indd 127 25.08.2011 14:10:09

128
3 Gallbladder
Block_engl_03.indd 128 25.08.2011 14:10:09

20
17
30
76
17
10
The shape and location of the gallbladder are highly variable.

But the gallbladder neck is always located in the porta hepatis,
caudal to the right branch of the portal vein.
20
30
17 76
10
The healthy gallbladder is a fluid-filled organ, usually

pear-shaped, that does not contain internal echoes.
Block_engl_03.indd 129 25.08.2011 14:10:09

130
3 Gallbladder
111 Gallbladder, portal vein, right kidney
112 Gallbladder fundus, right kidney
Block_engl_03.indd 130 25.08.2011 14:10:09

20
30
77
17
60
A variable-sized piece of liver is interposed

between the gallbladder and kidney.
20
30
14
60
The gallbladder always borders directly on the right kidney, but it may ap-
pear separate from the kidney when scanned through its lateral portion.
Block_engl_03.indd 131 25.08.2011 14:10:10

132
3 Gallbladder
113 Gallbladder neck, duodenum, right kidney
114 Gallbladder neck, small bowel, right kidney
Block_engl_03.indd 132 25.08.2011 14:10:10

Gallbladder in Transverse Flank Scans from Above Downward 133
60
20
14
33
76
The gallbladder neck is identified at the level

of the kidney in a high lateral transverse scan.
60
20
95
32
77
A scan through the gallbladder from the lateral side typically

displays the triad of the gallbladder, kidney, and liver.
Block_engl_03.indd 133 25.08.2011 14:10:10

134
3 Gallbladder
115 Gallbladder body, small bowel, right kidney
116 Gallbladder fundus, small bowel
Block_engl_03.indd 134 25.08.2011 14:10:10

Gallbladder in Transverse Flank Scans from Above Downward 135
60
20
95 77
32
The gallbladder is often obscured by bowel gas

when scanned from the lateral side.
60 20
95
77
31
The gallbladder fundus may extend

downward for some distance.
Block_engl_03.indd 135 25.08.2011 14:10:10

136
3 Gallbladder
117 Right kidney, liver
Block_engl_03.indd 136 25.08.2011 14:10:11

Gallbladder in Longitudinal Flank Scans from Posterior to Anterior 137
20
60
The kidney is the key landmark for locating the

gallbladder in the lateral longitudinal scan.
20
30
The gallbladder is consistently displayed

anterior to the right kidney.
Block_engl_03.indd 137 25.08.2011 14:10:11

138
3 Gallbladder
Block_engl_03.indd 138 25.08.2011 14:10:11

Gallbladder in Longitudinal Flank Scans from Posterior to Anterior 139
20
30
The gallbladder directly abuts

the liver posteriorly.
20
30
In most cases the gallbladder can be completely

surveyed in a series of lateral longitudinal scans.
Block_engl_03.indd 139 25.08.2011 14:10:11

140
3 Gallbladder
121 Regions of the gallbladder, Heister valves
122 Layered structure of the gallbladder wall
Block_engl_03.indd 140 25.08.2011 14:10:11

Details of Gallbladder 141
78
20
34 31
33
32
17
94
60
20 35
14
The Heister valves and gallbladder neck can often be clearly

identified in a longitudinal scan over the gallbladder.
78
20
94
30
76
94
The anterior wall of the gallbladder displays three distinct layers.

Usually its posterior wall is poorly delineated from the duodenum.
Block_engl_03.indd 141 25.08.2011 14:10:11

142
3 Gallbladder
Block_engl_03.indd 142 25.08.2011 14:10:12

Bile Ducts in Upper Abdominal Transverse Scans From Above Downward 143
21
4
36
18
1
10
20
90
The common duct is located

just anterior to the portal vein.
21 4
7
18
36
10 1
20
96
90
An upper abdominal longitudinal scan over the porta hepatis

displays a longitudinal section of the common duct
and a cross section of the hepatic artery.
Block_engl_03.indd 143 25.08.2011 14:10:12

144
3 Gallbladder
Block_engl_03.indd 144 25.08.2011 14:10:12

21
7
4
36
1
10
96
20 90
A portion of the common duct runs parallel

and anterior to the vena cava.
18
21
7
4
20
36 10 1
96
90
In most cases the common duct can be

clearly traced into the head of the pancreas.
Block_engl_03.indd 145 25.08.2011 14:10:12

146
3 Gallbladder
Block_engl_03.indd 146 25.08.2011 14:10:12

21
4
15
30
1
36 10
90
20
The common duct and hepatic artery are initially parallel to each other
in the porta hepatis. The common duct is lateral, the artery medial.
21
30
76
19
41
36 7
10
20
1
90
Below the porta hepatis, the common duct runs downward

while the hepatic artery curves into the field from the medial side.
Block_engl_03.indd 147 25.08.2011 14:10:13

148
3 Gallbladder
129 Common duct, portal vein, hepatic artery
Block_engl_03.indd 148 25.08.2011 14:10:13

Bile Ducts in Upper Abdominal Longitudinal Scans from Right to Left 149
93
4
36
17
10
20
The common duct appears anterior

and slightly lateral to the vena cava.
20
36
17
10
8
The common duct angles slightly

toward the lateral side as it descends.
Block_engl_03.indd 149 25.08.2011 14:10:13

150
3 Gallbladder
Block_engl_03.indd 150 25.08.2011 14:10:13

Bile Ducts in Upper Abdominal Longitudinal Scans from Right to Left 151
20
4
36
17
8
10
In most cases the rounded cross section of the common duct

can be clearly identified above the pancreatic head.
20
36 41
10
The common duct is clearly visible anterior to the

vena cava at the level of the pancreatic head.
Block_engl_03.indd 151 25.08.2011 14:10:13

Pancreas in Longitudinal Sections … p. 154
133 Duodenum lateral to head of pancreas
134 Head of pancreas, bile duct
136 Head of pancreas, hilar vessels, vena cava
137 Head of pancreas, superior mesenteric vein,
uncinate process
uncinate process
139 Body of pancreas, splenic vein
140 Body of pancreas, splenic vein, superior
mesenteric artery, aorta
142 Tail of pancreas, splenic artery and vein,
renal artery and vein
144 Tail of pancreas
Head of the Pancreas in Transverse

Sections … p. 166
145 Section cranial to head of pancreas, vena cava,
splenic vein
146 Head of pancreas, vena cava, superior mesenteric vein
147 Head of pancreas, vena cava, superior mesenteric
vein, uncinate process, common bile duct
148 Head of pancreas, vena cava, superior mesenteric
vein, uncinate process, gallbladder
Body of the Pancreas in Transverse

Sections … p. 170
149 Scan cranial to body of pancreas, celiac trunk
151 Body of pancreas, splenic vein, superior mesenteric
artery, aorta
152 Left renal artery and vein, superior mesenteric
artery and vein, aorta
Block_engl_04.indd 152 25.08.2011 14:10:30

Tail of the Pancreas in Transverse
Sections … p. 174
153 Tail of pancreas, splenic artery
154 Tail of pancreas, splenic vein
155 Tail of pancreas, gas in stomach
Transsplenic View of the Tail of the Pancreas

in Longitudinal Sections … p. 178
157 Scan posterior to tail of pancreas, spleen, kidney
158 Spleen, tail of pancreas, kidney
160 Scan anterior to tail of pancreas, spleen, stomach
Transsplenic View of the Tail of the Pancreas

in Transverse Sections … p. 182
Details of the Pancreas … p. 184

163 Transverse scan of pancreatic duct
164 Longitudinal scan of pancreatic duct
Block_engl_04.indd 153 25.08.2011 14:10:30

154
4 Pancreas
133 Duodenum lateral to head of pancreas
Block_engl_04.indd 154 25.08.2011 14:10:30

Pancreas in Longitudinal Sections 155
73
20 76
17 36
The head of the pancreas lies in the duodenal loop of the

duodenum and is bounded laterally by the duodenum.
20 73
4 41
17 36
10
The bile duct, hepatic artery, and portal vein

are located cranial to the head of the pancreas.
Block_engl_04.indd 155 25.08.2011 14:10:30

156
4 Pancreas
136 Head of pancreas, hilar vessels, vena cava
Block_engl_04.indd 156 25.08.2011 14:10:30

73
22
4 41
36
23 17
10
The bile duct runs posteriorly in the head of the pancreas to the papilla,
which usually cannot be visualized with ultrasound.
70
22
4
41
17
10
8
90
92
The head of the pancreas lies against the anterior surface of the vena cava
and is bordered cranially by the main trunk of the portal vein.
Block_engl_04.indd 157 25.08.2011 14:10:30

158
4 Pancreas

uncinate process

uncinate process
Block_engl_04.indd 158 25.08.2011 14:10:31

22
41
4 19
94
17 44
23 10
8
90
The uncinate process runs posteriorly around the mesenteric vein,

coming between that vessel and the vena cava.
22
41
4 19 94
44
10 8
90
The superior mesenteric vein marks the boundary

between the head and body of the pancreas.
Block_engl_04.indd 159 25.08.2011 14:10:31

160
4 Pancreas
140 ody of pancreas, splenic vein,

superior mesenteric artery, aorta
Block_engl_04.indd 160 25.08.2011 14:10:31

22 42
4 18 19
96
90
The body of the pancreas is the narrowest part

of the organ in its ventrodorsal dimension.
70
21
42
18 7
3
1 15
90
The celiac trunk is cranially adjacent to the body of the

pancreas. The splenic vein and body of the pancreas
cross over the superior mesenteric artery.
Block_engl_04.indd 161 25.08.2011 14:10:31

162
4 Pancreas

Block_engl_04.indd 162 25.08.2011 14:10:31

70
21
42
18 15
6 9
5
The left margin of the aorta marks the junction

between the body and tail of the pancreas.
21
43
5 18
6
9 15
A longitudinal scan at the junction of the body and tail

of the pancreas displays four vessels in cross section:
the splenic artery, splenic vein, renal artery, and renal vein.
Block_engl_04.indd 163 25.08.2011 14:10:32

164
4 Pancreas

Block_engl_04.indd 164 25.08.2011 14:10:32

21
43
74 5 18
6
15
9
The tail of the pancreas often has

a plump appearance in cross section.
21
43
15
The tail of the pancreas can be completely visualized

in an anterior scan only if acoustic conditions are good.
Block_engl_04.indd 165 25.08.2011 14:10:32

166
4 Pancreas
145 Section cranial to head of pancreas, vena cava,

splenic vein
146 Head of pancreas, vena cava, superior mesenteric vein
Block_engl_04.indd 166 25.08.2011 14:10:32

Head of the Pancreas in Transverse Sections 167
21
22 42
18
43
20
10 1
90
The body of the pancreas overlies the superior mesenteric vein.

All parts of the gland that lie to the right of the superior
mesenteric vein are designated as the head of the pancreas.
21
22
41 19
94
36 44
20 1
10
60
90
The uncinate process extends between

the vena cava and superior mesenteric vein.
Block_engl_04.indd 167 25.08.2011 14:10:32

168
4 Pancreas
147 Head of pancreas, vena cava, superior mesenteric vein,

uncinate process, common bile duct
148 Head of pancreas, vena cava, superior mesenteric vein,

uncinate process, gallbladder
Block_engl_04.indd 168 25.08.2011 14:10:32

Head of the Pancreas in Transverse Sections 169
21
22
41 19
30
20 36
1 94
10
60 90
The common bile duct is visible at the right border

of the pancreatic head in transverse section.
21 70
22
30 41 19
20
44
36 1 94
10
60
90
The head of the pancreas lies between the liver,

gallbladder, vena cava, and superior mesenteric vein.
Block_engl_04.indd 169 25.08.2011 14:10:33

170
4 Pancreas
149 Scan cranial to body of pancreas, celiac trunk
Block_engl_04.indd 170 25.08.2011 14:10:33

Body of the Pancreas in Transverse Sections 171
70
21
43
17 5
4 3
94
10 1
90
The body of the pancreas is bounded cranially by the celiac trunk

and its two branches, the hepatic artery and splenic artery.
4 21
70
41 42
17
36 7
5
10 1 43
90
The borders of the healthy pancreas form a

continuous outline from head to body to tail.
Block_engl_04.indd 171 25.08.2011 14:10:33

172
4 Pancreas
151 Body of pancreas, splenic vein,

superior mesenteric artery, aorta
152 Left renal artery and vein,

superior mesenteric artery and vein, aorta
Block_engl_04.indd 172 25.08.2011 14:10:33

Body of the Pancreas in Transverse Sections 173
21
70
42
45
18 43
7
41 44
10 1
90
The splenic vein is the landmark for locating the pancreas.

The superior mesenteric artery lies between the splenic vein and the aorta,
appearing as an echo-free spot surrounded by bright echoes.
70
21 7
18
1 15
10
9
90
When the renal vessels are displayed in a transverse scan,

usually the pancreas is no longer visualized.
Block_engl_04.indd 173 25.08.2011 14:10:33

174
4 Pancreas
153 Tail of pancreas, splenic artery
154 Tail of pancreas, splenic vein
Block_engl_04.indd 174 25.08.2011 14:10:33

Tail of the Pancreas in Transverse Sections 175
21
94
10
1
43
90
The tail of the pancreas is located well posteriorly,

on the left side of the aorta.
21
4 94
3 18
10 43
1
90
The tail of the pancreas is angled sharply posterior

from the body and extends a variable distance between the
stomach and the upper renal pole toward the splenic hilum.
Block_engl_04.indd 175 25.08.2011 14:10:34

176
4 Pancreas
155 Tail of pancreas, gas in stomach
Block_engl_04.indd 176 25.08.2011 14:10:34

Tail of the Pancreas in Transverse Sections 177
21
42 70
18
45
94
10
1
43
90
The junction between the body and tail of the pancreas

is located at the level of the left aortic margin.
70
42
18
94
10 43
1
90
The tail of the pancreas is the most difficult part

of the gland to evaluate with ultrasound.
Block_engl_04.indd 177 25.08.2011 14:10:34

178
4 Pancreas
157 Scan posterior to tail of pancreas, spleen, kidney
Block_engl_04.indd 178 25.08.2011 14:10:34

Transsplenic View of the Tail of the Pancreas in Longitudinal Sections 179
50
61
The tail of the pancreas is scanned intercostally through

the spleen. Kidney and spleen serve as landmarks.
50
43
61
18
The tail of the pancreas is located in the splenic hilum

between the spleen and the kidney.
Block_engl_04.indd 179 25.08.2011 14:10:34

180
4 Pancreas
160 Scan anterior to tail of pancreas, spleen, stomach
Block_engl_04.indd 180 25.08.2011 14:10:34

Transsplenic View of the Tail of the Pancreas in Longitudinal Sections 181
79
50
43 94
18
15
Interference from bowel gas is often encountered

caudal to the tail of the pancreas.
50 18
70
The stomach is a source of numerous artifacts

anterior to the tail of the pancreas.
Block_engl_04.indd 181 25.08.2011 14:10:34

182
4 Pancreas
Block_engl_04.indd 182 25.08.2011 14:10:35

Transsplenic View of the Tail of the Pancreas in Transverse Sections 183
50
18 61
70
15
43
94
In transverse sections as well, the spleen is used as an

acoustic window for scanning the tail of the pancreas.
70
15
43
61
94
The tail of the pancreas lies in an angle

between the spleen and the kidney.
Block_engl_04.indd 183 25.08.2011 14:10:35

184
4 Pancreas
163 Transverse scan of pancreatic duct
164 Longitudinal scan of pancreatic duct
Block_engl_04.indd 184 25.08.2011 14:10:35

Details of the Pancreas 185
24 21
22 70
30
42 45
20 94
19
43
41
44
The pancreatic duct has a variable course. It usually runs

in the ventrocranial part of the parenchyma, appearing
sonographically as two parallel echogenic lines.
24
94 70
20
21
94
45
42 18
5
In this plane the pancreatic duct appears as a fine,

tubular structure with a luminal diameter up to 3 mm.
It is located slightly anterior to the center of the gland.
Block_engl_04.indd 185 25.08.2011 14:10:35

Block_engl_05.indd 186 25.08.2011 14:10:49
Longitudinal Flank Scans of the Spleen … p. 188
165 Spleen, kidney
166 Splenic hilum, splenic vein
167 Spleen, stomach
168 Spleen, stomach
Transverse Flank Scans of the Spleen … p. 192

169 Spleen, kidney, stomach
170 Spleen, kidney, pancreas
171 Spleen, stomach
172 Spleen, small bowel
Details of the Spleen … p. 196

173 Accessory spleen
Block_engl_05.indd 187 25.08.2011 14:10:49

188
5 Spleen
165 Spleen, kidney
166 Splenic hilum, splenic vein
Block_engl_05.indd 188 25.08.2011 14:10:49

Longitudinal Flank Scans of the Spleen 189
50 79
61
The spleen is identified in the longitudinal flank scan as a

rounded triangle between the upper renal pole and the diaphragm.
50
94
18
96
A flank scan at the level of the hilum displays

the spleen in its greatest longitudinal dimension.
Block_engl_05.indd 189 25.08.2011 14:10:50

190
5 Spleen
167 Spleen, stomach
168 Spleen, stomach
Block_engl_05.indd 190 25.08.2011 14:10:50

Longitudinal Flank Scans of the Spleen 191
94
18
50
71
96
The spleen lies against the stomach

anteriorly and medially.
50
71
94
96
The spleen exhibits a typical crescent shape

in an anterior flank scan.
Block_engl_05.indd 191 25.08.2011 14:10:50

192
5 Spleen
169 Spleen, kidney, stomach
170 Spleen, kidney, pancreas
Block_engl_05.indd 192 25.08.2011 14:10:50

Transverse Flank Scans of the Spleen 193
92
70 50
94
61
43
A high transverse flank scan demonstrates the

typical triad of the spleen, kidney, and stomach.
92
50
70
94
43
61
18
The tail of the pancreas can usually be identified

in the splenic hilum next to the splenic vessels.
Block_engl_05.indd 193 25.08.2011 14:10:50

194
5 Spleen
171 Spleen, stomach
172 Spleen, small bowel
Block_engl_05.indd 194 25.08.2011 14:10:50

Transverse Flank Scans of the Spleen 195
70
50
92
92
18
94
61
The spleen may be deeply lobulated by septa.
50
92
92
77
61
Loops of small bowel are located medial

to the lower pole of the spleen.
Block_engl_05.indd 195 25.08.2011 14:10:51

196
5 Spleen
Block_engl_05.indd 196 25.08.2011 14:10:51

Details of the Spleen 197
50
51
18
Accessory spleens are most commonly found in the hilar region.
51
50
94
61
An accessory spleen is occasionally found at the lower pole.
Block_engl_05.indd 197 25.08.2011 14:10:51

Longitundinal Flank Scans of the Right Kidney
175 Kidney, liver, psoas muscle
178 Kidney, right renal vein
Transverse Flank Scans of the Right Kidney

179 Kidney, liver
180 Kidney, liver, right renal vein
181 Kidney, liver
182 Kidney, liver
Upper Abdominal Longitudinal Scans of

the Right Kidney from Right to Left … p. 208
183 Kidney, liver
184 Kidney, liver
185 Kidney, liver, renal cyst
186 Kidney, liver, renal cyst
Upper Abdominal Transverse Scans of

the Right Kidney from Above Downward … p. 212
187 Kidney, right renal vein, vena cava
188 Kidney, right renal vein, vena cava, right renal artery
189 Kidneys, right renal artery
190 Kidney, spleen, psoas muscle
Block_engl_06.indd 198 25.08.2011 14:11:06

Longitudinal Flank Scans of the Left Kidney
194 Kidney, renal vein, spleen, aorta
Transverse Flank Scans of the Left Kidney

195 Kidney, spleen, stomach
196 Kidney, left renal artery, spleen, stomach
197 Kidney, right colic flexure
Details of the Kidneys … p. 224

199 Medullary pyramids
200 Collecting system
Block_engl_06.indd 199 25.08.2011 14:11:06

200
6 Kidneys
Block_engl_06.indd 200 25.08.2011 14:11:06

Longitundinal Flank Scans of the Right Kidney from Posterior to Anterior 201
20
60
95
90
The right kidney is clearly demonstrated

through the acoustic window of the liver.
60
95
90
The kidneys slide downward along the

lumbar muscles during respiratory excursions.
Block_engl_06.indd 201 25.08.2011 14:11:06

202
6 Kidneys
178 Kidney, right renal vein
Block_engl_06.indd 202 25.08.2011 14:11:06

Longitundinal Flank Scans of the Right Kidney from Posterior to Anterior 203
20
60
95
The summation of portions of the pelvicalyceal system,

blood vessels, lymphatics, fatty tissue, and renal sinus
form an echogenic complex at the center of the kidney.
20
60
14
95
The fibrous renal capsule cannot be

visualized with ultrasound.
Block_engl_06.indd 203 25.08.2011 14:11:06

204
6 Kidneys
179 Kidney, liver
180 Kidney, liver, right renal vein
Block_engl_06.indd 204 25.08.2011 14:11:07

Transverse Flank Scans of the Right Kidney from Above Downward 205
20
92
92
60 92
The right kidney occupies a posterior site in the angle between

the spinal column, muscles, and right lobe of the liver.
20
92
60
14
1
90
Generally the renal hilar vessels can be clearly defined.
Block_engl_06.indd 205 25.08.2011 14:11:07

206
6 Kidneys
181 Kidney, liver
182 Kidney, liver
Block_engl_06.indd 206 25.08.2011 14:11:07

Transverse Flank Scans of the Right Kidney from Above Downward 207
20
92
60
1
95
The psoas muscle is located medial to the kidney.
20
92
60
1
95 77
In most cases the right kidney can be clearly visualized

as far as its upper pole when scanned from the lateral side.
Block_engl_06.indd 207 25.08.2011 14:11:07

208
6 Kidneys
183 Kidney, liver
184 Kidney, liver
Block_engl_06.indd 208 25.08.2011 14:11:07

Upper Abdominal Longitudinal Scans of the Right Kidney from Right to Left 209
20
60
Unlike the left kidney, the right kidney can be clearly visualized
from the anterior side using the liver as an acoustic window.
20
60
78
The lower pole of the kidney is often

obscured by overlying bowel gas.
Block_engl_06.indd 209 25.08.2011 14:11:08

210
6 Kidneys
185 Kidney, liver, *renal cyst
186 Kidney, liver, *renal cyst
Block_engl_06.indd 210 25.08.2011 14:11:08

Upper Abdominal Longitudinal Scans of the Right Kidney from Right to Left 211
20
*
60
Renal cysts are common, irrelevant incidental findings.
20
*
60
An anterior scan will often display

the entire right kidney in thin patients.
Block_engl_06.indd 211 25.08.2011 14:11:08

212
6 Kidneys
187 Kidney, right renal vein, vena cava
188 Kidney, right renal vein, vena cava, right renal artery
Block_engl_06.indd 212 25.08.2011 14:11:08

Upper Abdominal Transverse Scans of the Right Kidney from Above Downward 213
20
10
14
60
90
The renal vein enters the vena cava

at the level of the renal upper pole.
20
14
8
10
60
90
The renal artery is located posterior and superior to the renal vein,
which is noticeably larger than the artery in most patients.
Block_engl_06.indd 213 25.08.2011 14:11:08

214
6 Kidneys
189 Kidneys, right renal artery
Block_engl_06.indd 214 25.08.2011 14:11:09

Upper Abdominal Transverse Scans of the Right Kidney from Above Downward 215
20
8 77
60
95
90
The kidney slides downward on the

psoas muscle during inspiration.
20
92
60
77
95
90
The right lobe of the liver extends a variable

distance over the right kidney.
Block_engl_06.indd 215 25.08.2011 14:11:09

216
6 Kidneys
Block_engl_06.indd 216 25.08.2011 14:11:09

Longitudinal Flank Scans of the Left Kidney from Posterior to Anterior 217
50
79
61
95
A good acoustic window is not available

for scanning the left kidney.
50 79
61
95
The spleen extends laterally to the

approximate center of the left kidney.
Block_engl_06.indd 217 25.08.2011 14:11:09

218
6 Kidneys
194 Kidney, renal vein, spleen, aorta
Block_engl_06.indd 218 25.08.2011 14:11:09

Longitudinal Flank Scans of the Left Kidney from Posterior to Anterior 219
50 79 94
65 61
95
The lower half of the left kidney is covered laterally

by the descending colon and left colic flexure.
50
79
61 94
15 9
77
The aorta appears farthest from the transducer

in a longitudinal scan from the left flank.
Block_engl_06.indd 219 25.08.2011 14:11:10

220
6 Kidneys
195 Kidney, spleen, stomach
196 Kidney, left renal artery, spleen, stomach
Block_engl_06.indd 220 25.08.2011 14:11:10

Transverse Flank Scans of the Left Kidney from Above Downward 221
50
92 92
61
70
The ribs are an obstacle to scanning

the left kidney through the spleen.
50 61
92
9
70
The renal vessels are often clearly

visualized on the left side.
Block_engl_06.indd 221 25.08.2011 14:11:10

222
6 Kidneys
Block_engl_06.indd 222 25.08.2011 14:11:10

Transverse Flank Scans of the Left Kidney from Above Downward 223
78
61
The lower pole of the left kidney

is often difficult to define.
78
61
95
Because the kidney moves with respiratory excursions,

it can be fully visualized in most cases despite being
partially obscured by bowel gas and ribs.
Block_engl_06.indd 223 25.08.2011 14:11:10

224
6 Kidneys
199 Medullary pyramids
200 Collecting system
Block_engl_06.indd 224 25.08.2011 14:11:11

Details of the Kidneys 225
20
64 62
64
63
63
65
60
95
An imaginary line joining the bases of the hypoechoic

medullary pyramids forms a dividing line between the cortical
and medullary tissue in the ultrasound image.
20
62 78
64
64
94
65
95
Intense diuresis has caused a bandlike or stellate

fluid collection to appear in the renal pelvis.
Block_engl_06.indd 225 25.08.2011 14:11:11

Block_engl_07.indd 226 25.08.2011 14:11:26
Upper Abdominal Longitudinal Scans of the
Right Adrenal Gland from Right to Left … p. 228
201 Kidney, liver
202 Kidney, liver
203 Adrenal gland, liver
204 Adrenal gland, vena cava, renal artery
Upper Abdominal Transverse Scans of the

Right Adrenal Gland from Below Upward … p. 232
205 Kidney, vena cava
206 Kidney, renal vein, vena cava
207 Renal vein, vena cava
208 Adrenal gland, vena cava
Longitudinal Flank Scans of the

Left Adrenal Gland from Back to Front … p. 236
209 Kidney, spleen
210 Adrenal gland, kidney, spleen
212 Spleen, tail of pancreas
Details of the Adrenal Glands … p. 240

213 Layers of adrenal gland
Block_engl_07.indd 227 25.08.2011 14:11:26

228
7 Adrenal Glands
201 Kidney, liver
202 Kidney, liver
Block_engl_07.indd 228 25.08.2011 14:11:26

Upper Abdominal Longitudinal Scans of the Right Adrenal Gland from Right to Left 229
20
60
95
96
The right adrenal gland is located at the level of the

upper renal pole, medial and anterior to the right kidney.
20
60
95
96
In an upper abdominal longitudinal scan from the anterior aspect,

the kidney is used as a landmark for locating the right adrenal gland.
Block_engl_07.indd 229 25.08.2011 14:11:26

230
7 Adrenal Glands
203 Adrenal gland, liver
204 Adrenal gland, vena cava, renal artery
Block_engl_07.indd 230 25.08.2011 14:11:26

Upper Abdominal Longitudinal Scans of the Right Adrenal Gland from Right to Left 231
20
69
96
In a scan across the kidney from right to left, when the

upper renal pole is just disappearing from the image
the region of the right adrenal gland has been located.
20
10
69
96
The right adrenal gland extends behind

the vena cava, above the renal vessels.
Block_engl_07.indd 231 25.08.2011 14:11:27

232
7 Adrenal Glands
205 Kidney, vena cava
206 Kidney, renal vein, vena cava
Block_engl_07.indd 232 25.08.2011 14:11:27

Upper Abdominal Transverse Scans of the Right Adrenal Gland from Below Upward 233
20 30
76
10
60 1
90
The landmarks for identifying the right adrenal

gland region in transverse section are the kidney,
the inferior surface of the liver, and the vena cava.
20
30
77
14 10
60 1
90
The adrenal region is located above the renal hilar vessels.
Block_engl_07.indd 233 25.08.2011 14:11:27

234
7 Adrenal Glands
207 Renal vein, vena cava
208 Adrenal gland, vena cava
Block_engl_07.indd 234 25.08.2011 14:11:27

Upper Abdominal Transverse Scans of the Right Adrenal Gland from Below Upward 235
20
77
14 10
90
The right adrenal gland is identified just above the

renal pole, lateral and posterior to the vena cava.
20
77
10
1
69
90
The right adrenal gland appears as a narrow, triangular,

hypoechoic structure with an echodense rim.
Block_engl_07.indd 235 25.08.2011 14:11:27

236
7 Adrenal Glands
209 Kidney, spleen
Block_engl_07.indd 236 25.08.2011 14:11:27

Longitudinal Flank Scans of the Left Adrenal Gland from Back to Front 237
79
94 50 94
61
The left adrenal gland is usually more difficult

to locate than the right adrenal gland.
50
61
94
69
The left adrenal gland is identified between

the upper renal pole, spleen, and aorta.
Block_engl_07.indd 237 25.08.2011 14:11:27

238
7 Adrenal Glands
212 Spleen, tail of pancreas
Block_engl_07.indd 238 25.08.2011 14:11:28

Longitudinal Flank Scans of the Left Adrenal Gland from Back to Front 239
50
94
61
43
69
The left adrenal gland is frequently crescent-shaped.
50
94
43
18
70
1
96
The left adrenal gland often extends relatively

far downward toward the renal hilum.
Block_engl_07.indd 239 25.08.2011 14:11:28

240
7 Adrenal Glands
Block_engl_07.indd 240 25.08.2011 14:11:28

Details of the Adrenal Glands 241
20 41
4
17
10
8
10 69
90
The adrenal gland is seen to consist of three layers:

two echodense outer layers and a hypoechoic middle layer.
10
69
The adrenal cortex is hypoechoic,

and the medulla is hyperechoic.
Block_engl_07.indd 241 25.08.2011 14:11:28

Block_engl_08.indd 242 25.08.2011 14:11:42
Upper Abdominal Transverse Scans of the
Gastric Cardia from Above Downward … p. 244
215 Esophagus, aorta, liver
216 Cardia, aorta, liver
217 Cardia, gastric body, aorta, liver
218 Gastric body, aorta, liver
Upper Abdominal Longitudinal Scans

of the Stomach from Right to Left … p. 248
221 Cardia, liver
222 Gastric body, liver
Stomach in Upper Abdominal Longitudinal

Scans from Left to Right … p. 252
224 Antrum, liver, pancreas
227 Antrum, liver, duodenum
228 Antrum, duodenal bulb, pylorus
229 Duodenum, gallbladder, liver
Upper Abdominal Transverse Scans of the Antrum

and Duodenum from Above Downward … p. 260
232 Antrum, duodenum, liver, pancreas, gallbladder
234 Antrum, gallbladder
Details of the Stomach … p. 264

235 Layers of gastric wall
237 Gastric folds
238 Gastric folds
Block_engl_08.indd 243 25.08.2011 14:11:42

244
8 Stomach
216 Cardia, aorta, liver
Block_engl_08.indd 244 25.08.2011 14:11:42

Upper Abdominal Transverse Scans of the Gastric Cardia from Above Downward 245
* esophagus
21
12
* 71
96
10 1
96
94
The gastroesophageal junction is identified between

the liver, aorta, and crura of the diaphragm.
21
12
74 72
10
1
96
96 94
90
The cardia opens into a sharply tapered triangular

structure when viewed in transverse section.
Block_engl_08.indd 245 25.08.2011 14:11:42

246
8 Stomach
217 Cardia, gastric body, aorta, liver
218 Gastric body, aorta, liver
Block_engl_08.indd 246 25.08.2011 14:11:43

Upper Abdominal Transverse Scans of the Gastric Cardia from Above Downward 247
21
12
72
10
1
90
Next to the cardia, the gastric body presents a seemingly

chaotic pattern of solid, liquid and gaseous material.
21
17
17
10
1
72
20
90
Below the cardia, the gastric body

borders directly on the aorta.
Block_engl_08.indd 247 25.08.2011 14:11:43

248
8 Stomach
Block_engl_08.indd 248 25.08.2011 14:11:43

Upper Abdominal Longitudinal Scans of the Stomach from Right to Left 249
* esophagus
22
96 6
96
*
1
The abdominal esophagus is identified just to

the right of, and anterior to, the aorta.
* esophagus
22
96
3
96
* 1
90
The esophagus and cardia are located between the liver

and aorta in an upper abdominal longitudinal scan.
Block_engl_08.indd 249 25.08.2011 14:11:43

250
8 Stomach
221 Cardia, liver
Block_engl_08.indd 250 25.08.2011 14:11:44

Upper Abdominal Longitudinal Scans of the Stomach from Right to Left 251
96 21
72
74
The cardia and body of the stomach are located and

identified by first defining the gastroesophageal junction.
21
96
72
In subjects who have not been specially prepared,

the gastric body presents a heterogeneous echo
pattern located behind the left lobe of the liver.
Block_engl_08.indd 251 25.08.2011 14:11:44

252
8 Stomach
Block_engl_08.indd 252 25.08.2011 14:11:44

Stomach in Upper Abdominal Longitudinal Scans from Left to Right 253
21
72
The gastric body is consistently located

behind the left lobe of the liver.
21
73
42
The appearance of the stomach

depends on its degree of distention.
Block_engl_08.indd 253 25.08.2011 14:11:44

254
8 Stomach
Block_engl_08.indd 254 25.08.2011 14:11:45

21
73
42
Generally the fluid-filled stomach can be

clearly visualized with ultrasound.
21
45
73
42
19
A longitudinal scan at the center of the upper abdomen

displays the triad of the stomach, liver, and pancreas.
Block_engl_08.indd 255 25.08.2011 14:11:45

256
8 Stomach
227 Antrum, liver, duodenum
228 Antrum, duodenal bulb, *pylorus
Block_engl_08.indd 256 25.08.2011 14:11:45

21
4 73
17
75
10
The typical target pattern of the gastric antrum is seen most

clearly in a longitudinal scan at the inferior border of the liver.
22
73
75 *
A definite thickening of the muscularis

marks the location of the pylorus.
Block_engl_08.indd 257 25.08.2011 14:11:45

258
8 Stomach
229 Duodenum, gallbladder, liver
Block_engl_08.indd 258 25.08.2011 14:11:46

22
30
76
The descending duodenum is imaged

posterior to the gallbladder.
22
30
Bowel gas often produces artifacts

in the gallbladder region.
Block_engl_08.indd 259 25.08.2011 14:11:46

260
8 Stomach
Block_engl_08.indd 260 25.08.2011 14:11:46

Upper Abdom. Transv. Scans of the Antrum and Duodenum from Above Downward 261
21
24 73
20 42
19
41
30
10 1
The pancreas lies against the

posterior surface of the stomach.
24 21
20
73
75
45 42
30 19
41
10 1
The antrum extends to the right, coming between the

pancreas and liver. It is difficult to visualize at that location.
Block_engl_08.indd 261 25.08.2011 14:11:46

262
8 Stomach
234 Antrum, gallbladder
Block_engl_08.indd 262 25.08.2011 14:11:47

Upper Abdom. Transv. Scans of the Antrum and Duodenum from Above Downward 263
20
21
24
22
73
30 76
42
45 41 11
1
10
The second part of the duodenum lies between the liver,

gallbladder, vena cava, and head of pancreas.
22
21
30 73
76
20
The antrum often extends quite far downward, especially

when the stomach is full and the subject is standing upright.
Block_engl_08.indd 263 25.08.2011 14:11:47

264
8 Stomach
Block_engl_08.indd 264 25.08.2011 14:11:47

Details of the Stomach 265
21
73
With a high-resolution device and favorable scanning conditions,

five layers can be distinguished in the gastric wall.
21
73
A scan through the antrum is best for

differentiating the layers of the gastric wall.
Block_engl_08.indd 265 25.08.2011 14:11:47

266
8 Stomach
237 Gastric folds
238 Gastric folds
Block_engl_08.indd 266 25.08.2011 14:11:47

Details of the Stomach 267
21
73
90
The rugal folds of the stomach are demonstrated

most clearly in the fasted state.
21
73
94
In an upper abdominal transverse scan, the gastric folds produce

a confusing pattern in which numerous wall layers are seen.
Block_engl_08.indd 267 25.08.2011 14:11:48

Block_engl_09.indd 268 25.08.2011 14:12:00
Bladder in Longitudinal Sections … p. 270
239 Bladder, prostate, rectum
240 Bladder, ureteral orifice, prostate, rectum
241 Bladder, rectum
242 Bladder, bowel
Details of the Bladder … p. 274

243 Bladder, ureteral orifices
244 Bladder, inflow of urine
Block_engl_09.indd 269 25.08.2011 14:12:00

270
9 Bladder
239 Bladder, prostate, rectum
240 Bladder, ureteral orifice, prostate, rectum
Block_engl_09.indd 270 25.08.2011 14:12:00

Bladder in Longitudinal Sections 271
82
80
83
89
94
The full bladder appears in longitudinal section

as a triangular structure devoid of internal echoes.
80 82
83
84
89
94
The internal genitalia are seen posterior

to the bladder in the midsagittal scan.
Block_engl_09.indd 271 25.08.2011 14:12:00

272
9 Bladder
241 Bladder, rectum
242 Bladder, bowel
Block_engl_09.indd 272 25.08.2011 14:12:01

Bladder in Longitudinal Sections 273
80
77, 89
The anterior wall of the bladder is loosely attached to the anterior abdominal
wall by the vesicoumbilical fascia. This keeps gas-containing bowel loops from
coming between the abdominal wall and the anterior surface of the full bladder.
80
77
94
Bowel loops containing gas are seen

posterior to the bladder in the lateral scan.
Block_engl_09.indd 273 25.08.2011 14:12:01

274
9 Bladder
243 Bladder, ureteral orifices
244 Bladder, inflow of urine
Block_engl_09.indd 274 25.08.2011 14:12:01

Details of the Bladder 275
80
81 81
The ureters appear as fine tubular

structures in the posterior bladder wall.
*inflowing urine
80
89
Ultrasound can often demonstrate urine flowing

into the bladder from a ureteral orifice.
Block_engl_09.indd 275 25.08.2011 14:12:01

Block_engl_10.indd 276 25.08.2011 14:12:14
Prostate in Longitudinal Sections … p. 278
245 Prostate, rectum, bladder
247 Prostate, seminal vesicles
Prostate in Transverse Scans

from Below Upward … p. 282
249 Prostate, urethra, bladder
251 Prostate, urethra, bladder, rectum
252 Seminal vesicles, rectum, bladder,
ampulla of vas deferens
Block_engl_10.indd 277 25.08.2011 14:12:14

278
10 Prostate
Block_engl_10.indd 278 25.08.2011 14:12:15

Prostate in Longitudinal Sections 279
80
83
84
89
94
The prostate displays a bulbous

shape in longitudinal section.
80
83
84
89
94
The rectum usually appears as an air-filled

structure posterior to the prostate.
Block_engl_10.indd 279 25.08.2011 14:12:15

280
10 Prostate
Block_engl_10.indd 280 25.08.2011 14:12:15

Prostate in Longitudinal Sections 281
81
80
94 83
84
89
94
The seminal vesicles are in contact with

the bladder over their full length.
94 81
80
84
89
94
The seminal vesicles are located

lateral and superior to the prostate.
Block_engl_10.indd 281 25.08.2011 14:12:15

282
10 Prostate
Block_engl_10.indd 282 25.08.2011 14:12:15

Prostate in Transverse Scans from Below Upward 283
80
82
83
The prostate presents an elliptical “chestnut”

shape when viewed in transverse section.
80
82
83
The middle lobe of the prostate sometimes

bulges a short distance into the bladder lumen.
Block_engl_10.indd 283 25.08.2011 14:12:15

284
10 Prostate
251 Prostate, urethra, bladder, rectum
252 Seminal vesicles, rectum, bladder, *ampulla of

vas deferens
Block_engl_10.indd 284 25.08.2011 14:12:16

83
82 83
89
The urethra appears as a round,

hypoechoic structure within the prostate.
80
* *
84
89
The rectum is consistently visualized

posterior to the prostate.
Block_engl_10.indd 285 25.08.2011 14:12:16

286
10 Prostate

vas deferens

vas deferens
Block_engl_10.indd 286 25.08.2011 14:12:16

80
* *
84
89
The seminal vesicles are approximately 5 cm long and 1 cm

in diameter and are located on the posterior bladder wall.
80
84 * * 84
89
The vasa deferentia are located between

the seminal vesicles and bladder.
Block_engl_10.indd 287 25.08.2011 14:12:16

Block_engl_11.indd 288 25.08.2011 14:12:28
Uterus in Longitudinal Sections
from Left to Right … p. 290
255 Uterus, vagina, bladder, rectum
258 Ovary
Uterus in Transverse Sections

259 Vagina, bladder, rectum
260 Vagina, bladder
262 Uterus, bladder
263 Uterus, bladder, ovaries
Block_engl_11.indd 289 25.08.2011 14:12:28

290
11 Uterus
Block_engl_11.indd 290 25.08.2011 14:12:28

Uterus in Longitudinal Sections from Left to Right 291
80
85 86
89
The vagina appears behind the bladder as an elongated,

hypoechoic structure with a central band of higher-level echoes.
80
86
85
89
The uterus consists of the fundus, corpus, and cervix.
Block_engl_11.indd 291 25.08.2011 14:12:29

292
11 Uterus
258 Ovary
Block_engl_11.indd 292 25.08.2011 14:12:29

Uterus in Longitudinal Sections from Left to Right 293
77 80
86
85
89
The uterine cavity is visible sonographically

only during menstruation and pregnancy.
80
88
86
The ovaries flank the superior border

of the full urinary bladder.
Block_engl_11.indd 293 25.08.2011 14:12:29

294
11 Uterus
260 Vagina, bladder
Block_engl_11.indd 294 25.08.2011 14:12:29

Uterus in Transverse Sections from Below Upward 295
80
86
89
The vaginal lumen has a streaklike

appearance in transverse section.
80
86
The uterus impresses on the posterior bladder wall.
Block_engl_11.indd 295 25.08.2011 14:12:29

296
11 Uterus
262 Uterus, bladder
Block_engl_11.indd 296 25.08.2011 14:12:30

80
86
89
Transverse scan of the female pelvis displays, from anterior to posterior,

the urinary bladder, vesicouterine pouch, uterus, and rectum.
80
85
With the bladder distended, the uterus

can be clearly visualized from the anterior side.
Block_engl_11.indd 297 25.08.2011 14:12:30

298
11 Uterus
Block_engl_11.indd 298 25.08.2011 14:12:30

80
88
87
85
The ovaries are usually located lateral

to the uterus at the level of the uterine corpus.
80
87
88
85
The ovaries appear as rounded structures approximately

3 cm long and are extremely variable in their location.
Block_engl_11.indd 299 25.08.2011 14:12:30

Block_engl_12_u-letzte-S.indd 300 25.08.2011 14:14:38
Left Thyroid Lobe in Longitudinal Scans
from Right to Left … p. 302
265 Isthmus of thyroid gland
267 Left lobe of thyroid gland, sternohyoid muscle,
sternothyroid muscle
270 Left lobe of thyroid gland, common carotid artery
271 Internal jugular vein, sternocleidomastoid muscle
Left Thyroid Lobe in Transverse Scans

273 Left lobe of thyroid gland, common carotid artery,
internal jugular vein
277 Left lobe of thyroid gland

302
12 Thyroid Gland

Left Thyroid Lobe in Longitudinal Scans from Right to Left 303
100
107 107
The trachea is located directly behind

the isthmus of the thyroid gland.
100
The thyroid gland is imaged with a

high-resolution transducer.

304
12 Thyroid Gland



101, 102
100
Scant vascularity is seen in the

normal thyroid parenchyma.
101, 102
100
The sternohyoid and sternothyroid muscles

are anterior to the thyroid gland.

306
12 Thyroid Gland

270 Left lobe of thyroid gland, common carotid artery

100, 102
100
Normal thyroid parenchyma

has a homogeneous echo pattern.
101, 102
100
106
The thyroid gland narrows markedly

in the lateral direction.

308
12 Thyroid Gland

103
106
The common carotid artery is in contact

with the lateral aspect of the thyroid gland.
103
103
105
The large jugular vein appears lateral

to the common carotid artery.

310
12 Thyroid Gland



Left Thyroid Lobe in Transverse Scans from Below Upward 311
103
101, 102
100
105
106
The large vessels in the neck

run just lateral to the thyroid gland.
101, 102 103
100 105
106
The common carotid artery appears just lateral

to the thyroid gland in a transverse scan.

312
12 Thyroid Gland



101, 102 103
100
106 105
The jugular vein appears as a hypoechoic structure, not completely

circular, located adjacent to the common carotid artery.
101, 102
103
100
106
105
The sternocleidomastoid is a powerful muscle

located anterior and lateral to the thyroid gland.

314
12 Thyroid Gland

100
The thyroid gland is a butterfly-shaped organ

with smooth borders and high-level internal echoes.
100
The parathyroid glands are located posterior to the lateral

and superior poles of the thyroid gland. They may
not be visible at ultrasound unless they are enlarged.

Normal Sonographic Dimensions
of the Pancreas, Spleen, and Kidneys
Pancreas Head < 30 mm

Body < 25 mm
<2
< 25 mm 5m Tail < 25 mm
m
m
m
30
<
Pancreatic duct
< 2 mm
< 2 mm
Pancreatic duct
Spleen In longitudinal
flank scan:
m Length < 110 mm
< 40 m Thickness < 40 mm
m
0m
11
<
Kidneys length 100–120 mm

13–25 mm
width 50–70 mm
50–70 mm
Width of parenchyma:
13–25 mm
Parenchymal-pelvic
100–120 ratio:
mm 60 years or younger 1.6:1
Over 60 years 1.1 :1

of Major Vessels
Aorta
< 25 mm
Cranial part
< 20 mm
Caudal part
Vena cava
< 20 mm
Portal vein
< 13 mm
of the Liver, Gallbladder, and Bile Duct
Liver Craniocaudal
< 140 mm
Antero-
posterior
120–140 < 120 mm
mm
Angle of
inferior border:
In longitudinal Left < 30°
section Right < 45°
120–130 mm
In transverse section
Gallbladder Length
< 4 mm
< 120 mm
m Width
0m
<4 < 40 mm
< 120 mm Wall thickness
< 4 mm
Bile duct Normal width

< 6 mm
After chole-
cystectomy
6 mm < 9 mm
of the Prostate and Thyroid Gland
Prostate Width < 45 mm

Depth < 35 mm
Length < 35 mm
Volume < 25 mL
< 35 mm
In longitudinal
section
< 35 mm
< 45 mm
Thyroid gland Length 40–70 mm

Width 10–30 mm
40–70 mm Depth 10–20 mm
Volume in men:
< 25 mL
Volume in women:
In longitudinal < 20 mL
section
10–20 mm
10–30
mm
1 Aorta 60 Right kidney
2 Iliac artery 61 Left kidney
3 Celiac trunk 62 Renal cortex
4 Hepatic artery 63 Renal columns
5 Splenic artery 64 Pyramids
6 Left gastric artery 65 Renal pelvis
7 Superior mesenteric artery 66 Ureter
8 Right renal artery 67 –
9 Left renal artery 68 –
69 Adrenal gland
10 Vena cava
11 Left hepatic vein 70 Stomach
12 Middle hepatic vein 71 Fundus of stomach
13 Right hepatic vein 72 Body of stomach
14 Right renal vein 73 Antrum of stomach
15 Left renal vein 74 Cardia
16 Iliac vein 75 Duodenal bulb
17 Portal vein 76 Duodenum
18 Splenic vein 77 Small bowel
19 Superior mesenteric vein 78 Right colic flexure
79 Left colic flexure
20 Right lobe of liver
21 Left lobe of liver 80 Bladder
22 Quadrate lobe 81 Opening of ureter
23 Caudate lobe 82 Urethra
24 Ligamentum teres 83 Prostate
25 Ligamentum venosum 84 Seminal vesicle
26 Lateral segment 85 Uterus
27 Medial segment 86 Vagina
28 Anterior segment 87 Right ovary
29 Posterior segment 88 Left ovary
89 Rectum
30 Gallbladder
31 Fundus of gallbladder 90 Spinal column
32 Body of gallbladder 91 Symphysis pubis
33 Neck of gallbladder 92 Acoustic shadow
34 Infundibulum 93 Gas
35 Spiral folds 94 Artifact
36 Bile duct 95 Psoas muscle
37 Cystic duct 96 Diaphragm
97 Pelvic bone
40 Pancreas 98 Heart
41 Head of pancreas
42 Body of pancreas 100 Thyroid gland
43 Tail of pancreas 101 Sternohyoid muscle
44 Uncinate process 102 Sternothyroid muscle
45 Pancreatic duct 103 Sternocleidomastoid muscle
104 Omohyoid muscle
50 Spleen 105 Internal jugular vein
51 Accessory spleen 106 Common carotid artery
107 Tracheal cartilage

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Block_engl_00.indd 10 25.08.

Block_engl_00.indd 1 25.08.2011 14:08:30

Upper abdominal longitudinal scan, center

Lower abdominal longitudinal scan, center

Block_engl_00.indd 2 25.08.2011 14:08:30

Block_engl_00.indd 3 25.08.2011 14:08:30

Upper abdominal longitudinal scan, right side

Upper abdominal longitudinal scan, left side

Block_engl_00.indd 4 25.08.2011 14:08:31

Block_engl_00.indd 5 25.08.2011 14:08:31

Upper abdominal transverse scan, center

Lower abdominal transverse scan, center

Block_engl_00.indd 6 25.08.2011 14:08:31

Block_engl_00.indd 7 25.08.2011 14:08:31

Upper abdominal transverse scan, right side

Upper abdominal transverse scan, left side

Block_engl_00.indd 8 25.08.2011 14:08:32

Block_engl_00.indd 9 25.08.2011 14:08:32

Longitudinal flank scan, right side

Longitudinal flank scan, left side

Block_engl_00.indd 10 25.08.2011 14:08:32

Block_engl_00.indd 11 25.08.2011 14:08:32

Transverse flank scan, right side

Transverse flank scan, left side

Block_engl_00.indd 12 25.08.2011 14:08:32

Block_engl_00.indd 13 25.08.2011 14:08:32

Aorta and Vena Cava in Infrarenal Transverse

Splenic Artery and Vein in Longitudinal Sections … p. 40

Block_engl_01.indd 14 25.08.2011 14:09:09

Renal Artery and Vein in Longitudinal Sections … p. 50

Right Renal Artery and Vein in Transverse Sections … p. 54

Left Renal Artery and Vein in Longitudinal Sections … p. 58

Vessels of the Porta Hepatis in Longitudinal Sections … p. 62

Vessels of the Porta Hepatis in Transverse Sections … p. 68

Block_engl_01.indd 15 25.08.2011 14:09:09

1 Passage of aorta and vena cava through diaphragm

2 Left gastric artery

Block_engl_01.indd 16 25.08.2011 14:09:10

Just below the diaphragm, the vena cava is surrounded by

The left gastric artery is identified as a

Block_engl_01.indd 17 25.08.2011 14:09:10

Block_engl_01.indd 18 25.08.2011 14:09:10

After arising from the aorta, the celiac trunk

The proximal part of the celiac trunk

Block_engl_01.indd 19 25.08.2011 14:09:10

Block_engl_01.indd 20 25.08.2011 14:09:10

The celiac trunk runs slightly to the right,

The splenic artery branches from

Block_engl_01.indd 21 25.08.2011 14:09:11

7 Superior mesenteric artery

8 Superior mesenteric artery

Block_engl_01.indd 22 25.08.2011 14:09:11

The superior mesenteric artery arises just below

The root of the superior mesenteric artery

Block_engl_01.indd 23 25.08.2011 14:09:11

9 Superior mesenteric artery and splenic vein

10 Left renal vein and right renal artery

Block_engl_01.indd 24 25.08.2011 14:09:11

The left renal vein is physiologically compressed

Block_engl_01.indd 25 25.08.2011 14:09:11

11 Infrarenal aorta and vena cava

12 Infrarenal aorta and vena cava

Block_engl_01.indd 26 25.08.2011 14:09:11