By Bates J.
A complete consultant to belly ultrasound, together with simple anatomy, strategy and ultrasound appearances including the commonest pathological tactics. may be hugely illustrated with prime quality scans, many in color.
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Extra info for Abdominal Ultrasound: How, Why and When
Example text
23 (A) Configuration of the hepatic venous system. (B) Inferior middle hepatic vein (arrow) arising from the IVC. 25 TS through the epigastrium, demonstrating the normal splenic vein with flow towards the liver. Note the change from red to blue as the vessel curves away from the transducer. reverberation echoes inside the gallbladder, particularly in the near field. 24 Main portal vein at the porta hepatis demonstrating hepatopetal flow. The higher velocity hepatic artery lies adjacent to the Main portal vein (arrow).
The reflective surface of the stones and distal shadowing are apparent and the anterior gallbladder wall can be demonstrated with correct focusing and good technique (Fig. 16). Do not confuse the appearances of a previous cholecystectomy, when bowel in the gallbladder fossa casts a shadow, with a contracted, stone-filled gallbladder. 15 Postprandial, contracted gallbladder, with consequently thickened wall. (Fig. 17). The gallbladder itself is abnormally small, rather than just contracted. Cystic fibrosis also carries an increased incidence of gallstones because of the altered composition of the bile and bile stasis and the wall might be thickened and fibrosed from cholecystitis.
13). Other, less common options include dissolution therapy and extracorporeal shock wave lithotripsy (ESWL). 5 If the cystic duct is obstructed, usually by a stone which has failed to pass through to the CBD, the normal flow of bile from the gallbladder is interrupted. Chronic cystic duct obstruction causes the bile to be replaced by mucus secreted by the lining of the gallbladder, resulting in a mucocoele. The biliary ducts remain normal in calibre. If the gallbladder looks dilated, make a careful search for an obstructing lesion at the neck; a stone in the cystic duct is more difficult to identify on ultrasound as it is not surrounded by echo-free bile (Fig.