Basic Abdominal Ultrasound Exam

Question 1

Basic Abdominal Ultrasound Includes…

Answer 1

Liver, Gallbladder, Spleen, Kidneys, Urinary Bladder

Question 2

Liver Lobes

Answer 2

4 lobes, 4 sublobes, 2 processes. Left lobe(left lateral, medial) Quadrate, Right Lobe(Medial, lateral) Caudate(caudate process, papillary process).

Question 3

Portal Veins

Answer 3

Hyperechoic walls(fibrofatty tissue)

Question 4

Hepatic Arteries

Answer 4

Difficult to visualize, may be identified near the portal hepatis - use doppler to differentiate from portal veins and common bile duct.

Question 5

Hepatic Veins

Answer 5

Lack hyperechoic walls and can be traced to the caudal vena cava.

Question 6

Liver Approach

Answer 6

Subcostal and intercostal

Question 7

Liver size

Answer 7

Subjective assessment, consider breed and confirmation. Radiograph can provide better estimation of normal vs abnormal.

Question 8

Liver Appearance on US

Answer 8

Uniform, coarser, and less echogenic than spleen, similar of slightley greater echogenicity than right kidneyy. Smooth, sharp margins.

Question 9

Gallbladder

Answer 9

Round to oval anechoic structure with distal acoustic enhancement.

Question 10

Gallbladder Appearance

Answer 10

Walls may or may not be visible. Size variable depending on last meal. Cats may be bilobed.

Question 11

Gallbladder Wall - Cats

Answer 11

Cats less than 1 mm(usually 0.4 mm), anything greater is indicative of disease. Less than 1 mm cannot rule out presence of mild chronic inflammation.

Question 12

Gallbladder Wall - Dogs

Answer 12

2-3 mm

Question 13

Biliary Tract

Answer 13

Intrahepatic ducts not typically seen in normal patients. Common Bile Duct(CBD) often difficult to see due to bowel gas.

Question 14

Common Bile Duct

Answer 14

Tubular Structure with thin echogenic Walls with no doppler signal(differentiate from hepatic vessels).

Question 15

CBD Dogs

Answer 15

Normal is 3mm in diameter

Question 16

CBD Cats

Answer 16

Normal is 4 mm in diameter. Greater or equal to 5 mm is suggestive of post hepatic obstruction.

Question 17

Liver Scanning Planes

Answer 17

6 sagittal views
 Left lateral  Left lateral, toward midline
 Midline
 Gallbladder  Right lateral, toward
midline
 Gallbladder  Right lateral, cranial  Right lateral, caudal
(caudate)
4 transverse views (may need
to image right and left sides
separately)
▪ Cranial
▪ Mid
▪ Caudal

Question 18

Spleen Anatomy

Answer 18

Head(dorsal extremity), Body(vascular Hilus), Tail

Question 19

Spleen Landmarks

Answer 19

Position dependent on stomach distension and size of other abdominal organs. Located in left lateral abdomen, caudal to the liver and stomach, vental/lateral to the left kidnet. Head extends cranially and laterally to 12 rib space.

Question 20

Gastrosplenic Ligament

Answer 20

Where head of spleen attaches to stomach.

Question 21

Spleen dog vs cat

Answer 21

Dog- head attatches to stomach then crosses midline ventrally
Cat- head attatches to stomach then runs along the left body wall.

Question 22

Spleen Size

Answer 22

Subjective, effected by some sedatives.
Dog ~2.5 cm or less mid-body level.
Cats 1 cm or less mid-body level.

Question 23

Spleen Shape

Answer 23

Elongated with smooth Echogenic capsule. Head is fixed, body can be anywhere.

Question 24

Spleen Echogenicity

Answer 24

Uniform, smooth, homogoneous and hyperechoic to liver or renal cortex/medulla.

Question 25

Splenic Vasculature

Answer 25

Veins, no defined walls, arteries not seen.

Question 26

Spleen Scan Plans

Answer 26

▪ 4 SAGITTAL/4 TRANSVERSE VIEWS ▪ SPLENIC HEAD (DORSAL SPLEEN) ▪ CRANIAL BODY ▪ MID-BODY (HILUS) ▪ TAIL ▪ COMPARISON VIEW OF LIVER VS. SPLEEN

Question 27

Left Kidney Landmarks

Answer 27

Left lateral retroperitoneal space, use 13th rib as landmark, dorsal/medial to the spleen.

Question 28

Right Kidney Landmarks

Answer 28

Right lateral retroperitoneal space, tucked under ribcage in dogs, use 13th rib as landmark, caudate lobe of liver(renal fossa)

Question 29

Renal Anatomy

Answer 29

Hypoechoic to spleen, iso to hypoechoic to liver. Medulla Hypoechoic to cortex. Distinct corticomedullary junction. Pelvis and diverticulae(collecting system) not usually visible, fat within the renal sinus may shadow like mineralization.

Question 30

Kidney Size/Shape

Answer 30

Dogs vary in size, bean shaped. Cats ~3-5 cm, more rounded, more mobile and can be pushed away by transducer. Symmetry important.

Question 31

Collecting System(Renal)

Answer 31

Pelvis and ureter typically not seen, if visualized normal diameter is less than 2 mm. Diuresis may lead to mild renal pelvic dilation. Evaluate for calculi/mineralization.

Question 32

Renal Vasculature

Answer 32

Artery and vein enter at hilus. Vein ventral to artery.

Question 33

Renal Capsule

Answer 33

Smooth, Hyperechoic

Question 34

Kidney Echogenicity

Answer 34

Cortex hypoechoic to spleen, iso-hypoechoic to liver. Medulla is hypoechoic to cortex. Distinct cortico-medullary junction.

Question 35

Kidney Scan Planes

Answer 35

▪ 4 SAGITTAL VIEWS ▪ MEDIAL ▪ MEDIAL W/PELVIS ▪ MID (W/ AND W/O MEASUREMENT) ▪ LATERAL * 3 TRANSVERSE VIEWS (SLIDE) * CRANIAL * MID * CAUDAL * COMPARE KIDNEY VS. LIVER (ONE OR BOTH KIDNEYS)

Question 35

Differences of Right vs Left Kidney

Answer 35

Dogs- Right cranial and intimate with renal fossa of caudate lover lobe. Deepchested dogs may be difficult and subcostal view may be off, intercostal view can clean up the image.

Question 36

Urinary Bladder Wall

Answer 36

Wall will apppear as thin hyperechoic line. May see layers- Hyperechoic outer serosal, hypoechoic muscularis layer, hyperechoic submucosa/mucosa.

Question 36

Bladder Wall Thickness

Answer 36

Varies with distension. Dogs- 2.3 mm in minimal distended, 1.4 in moderately distended Cats- 1.3 to 1.7 mm is normal Small protuberances at dorsocaudal trigone or ureter openings.

Question 37

Bladder Landmarks

Answer 37

Caudal abdomen, mid-line. Blood vessels and lymph nodes dorsal, colon dorsal or dorsolaterally.

Question 38

Urinary Bladder Scan Planes

Answer 38

3 Sagital -Lateral to right -mid/trigone -lateral to left 3 Transverse -cranial -mid -caudal(trigone)

Question 39

What to include for Teleradiology Consult(Basic/Beginners)

Answer 39

Sag/Trans of every normal organ with annotations. -Liver: atleast sag/trans of left, central, and right liver and caudate lobe/R kidney junction. -GB: Sag/trans. Treat as own site -Spleen: Sag/trans of head, body and tail. If possible comparison view of it with liver and with L kidney -Kidneys- Sag(with and without measurements) and transverse of each kidney -Urinary Bladder- # of images submitted depends on distension. Sag/Trasn of apex, body and trigone.

Question 40

What to include for Teleradiology Consult(Experienced- in addition to basic list)

Answer 40

-Adrenals: Sag of each with /without measurements. If abnormality present assess and save in transverse. - Stomach: measure wall thickness in a few locations. Assess and record representative images -Duodenum: SAg/Trans, measure wall -SI: save a few images with/without measurements -Pancreas: save representative images -Colon: Learn how to trace colon and save representative images measuring wall. Assess ileocolic junction and ileum if possible. -Lymph Nodes/Peritoneum: Assess for any lymphadenopathy, including sublumbar/medial iliac lymph nodes and take images especially if abnormal. Assess peritoneum for changes in echogenicity and the presence of effusion. Record images of abnormalities(peritonitis, mesenteric edema. -Major Vessels: Aorts, Caudal Vena Cava and Portal Vein and record any abnormalities.

Question 41

Measure organs

Answer 41

Adrenals, Renal length +/- width, Urinary bladder wall, gallbladder wall, GI wall thickness, Lymph nodes.

Question 42

Focal Abnormalities

Answer 42

Annotate organ or structures you think abnormality is in and/or the surrounding landmarks. Provide images with/without measurements.