Table Of ContentAbdominal Ultrasound: Step by Step
Berthold Block, MD
Private Practice
Braunschweig
Germany
2nd edition
912 Illustrations
Thieme
Stuttgart · New York
Library of Congress Cataloging-in-Publication Data is available from the publisher.
This book is an authorized translation of the 4th German edition published and copyrighted 2009 by
Georg Thieme Verlag, Stuttgart, Germany. Title of the German edition: Der Sono-Trainer: Schritt-
für-Schritt-Anleitungen für die Oberbauchsonographie.
Translator: Terry C. Telger, Fort Worth, TX, USA
Illustrators: Viorel Constantinescu, Bucharest and Jörg Decker, Stuttgart
1st Chinese edition 2008
1st English edition 2004
1st French edition 2005
1st German edition 2000
2nd German edition 2003
3rd German edition 2005
4th German edition 2009
1st Korean edition 2005
1st Russian edition 2007
1st Spanish edition 2011
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Preface to the Second Edition
The first edition was published in 2004 as The Practice of Ultrasound. My goal
at that time was to walk the user through the basic principles of upper abdominal
ultrasound scanning. I am pleased that this concept is being revived and that a
second edition of the book can now be published. Once again the author
recommends keeping the book close at hand during the ultrasound examination.
The closing chapter of this edition serves as a “Sono Consultant.” It has been
designed to provide systematic guidance in interpreting suspicious findings and
determining how ultrasound can be applied to specific clinical questions.
Several of my colleagues supplied me with valuable ultrasound images for
inclusion in the previous edition. For the current edition I am particularly
indebted to Dr. Johannes Linder, who has again provided me with high-quality
images drawn from his clinical practice.
I wish my readers success in learning this modality and hope that they enjoy
the practice of abdominal ultrasound scanning.
Berthold Block, Braunschweig, Germany
Acknowledgments
I express my thanks to the following colleagues, who contributed images that I
did not have in my own files, supplied me with images of better quality, or
helped me with their comments and advice.
Christian Boemeke, MD
Joachim Dembowski, MD
Matthias Geist, MD
Dipl.-Med. Beate Geyer
Stefan Hänel, MD
Peter Irresberger
Meinolf Karthaus, MD,
Associate Professor
Ingo Kluthe, MD
Horst Kierdorf, MD, Professor
Bernd Krakamp, MD
Ingo Krenz, MD
Ralf Kuhlmann, MD
Hubert Langhorst, MD
Bernd Limberg, MD, Professor
Johannes Linder, MD
Bernd Milbert, MD
Hilmar Milbradt, MD
Joachim Pieper, MD
Roland Rother, MD
Harwig Schoendube, MD
I extend special thanks to Professor Hartmut Schmidt, MD, Münster. I also thank
Mr. Viorel Constantinescu for turning my rough sketches into precise sectional
diagrams.
The great majority of ultrasound images were obtained with a Siemens
scanner. The author is grateful to the Siemens Corporation for generously
providing the scanner on loan.
I thank the staff at Thieme Publishers Stuttgart for their constant and
courteous help and support.
Berthold Block
Table of Contents
1 General
How to Use This Book
Examination Technique and Equipment
Who do you examine first when learning to scan?
How do you adjust the ultrasound machine?
What can you do with the transducer?
2 Basic Physical and Technical Principles
Ultrasound
Definitions
Propagation of sound
Production and detection of ultrasound waves: the pulse-echo principle
Diagnostic ultrasound: propagation of ultrasound in biological tissue
Producing an Image
A-Mode
B-Mode
M-Mode
Artifacts
Noise
Acoustic shadowing
Posterior acoustic enhancement
Reverberations
Beam-width artifact
Side-lobe artifact
Mirror-image artifact
Lateral edge shadow
3 Blood Vessels: The Aorta and its Branches, the Vena Cava and its
Tributaries
Organ Boundaries
Locating the aorta and vena cava
Demonstrating the aorta and vena cava in their entirety
Organ Details
Demonstrating arterial and venous pulsations
Evaluating the vessel walls and lumina
Identifying and defining the branches of the aorta and vena cava
Anatomical Relationships
Relationship of the aorta and vena cava to the diaphragm, liver, and cardia
Area surrounding the celiac trunk and the course of the hepatic artery,
splenic artery, and left gastric artery
Superior mesenteric artery, splenic vein, and renal vessels
Iliac vessels
Lymph nodes near the retroperitoneal vessels
4 Liver
Organ Boundaries
Locating the liver
Imaging the liver in its entirety
Organ Details
Shape
Size
Parenchymal pattern
Vessels of the liver
Division of the liver into lobes, segments, and subsegments
The portal vein and its branches
Anatomical Relationships
Relationship of the left portion of the liver to the heart and stomach
Relationship of the central portion of the liver to the vena cava, stomach,
and pancreas
Relationship of the right portion of the liver to the gallbladder, duodenum,
and kidney
Ascites
5 Porta Hepatis
Organ Boundaries: Identifying the Vessels in the Porta Hepatis
Vena cava and portal vein
Hepatic artery and bile duct
Transverse and longitudinal survey of the porta hepatis
Organ Details: Details of the Vessels in the Porta Hepatis
Portal vein
6 Gallbladder
Organ Boundaries
Locating the gallbladder
Imaging the entire gallbladder
Variable position of the gallbladder
Nonvisualization of the gallbladder
Organ Details
Regions of the gallbladder
Size of the gallbladder
Variable shape of the gallbladder
Gallbladder wall
Gallbladder contents
Special acoustic phenomena in gallbladder scanning
Anatomical Relationships
Relationship of the gallbladder to the liver
Relationship of the gallbladder to the portal vein
Relationship of the gallbladder to the antrum, bulb, and duodenum
7 Pancreas
Organ Boundaries
Locating the pancreas
Imaging the entire pancreas
Variable shape of the pancreas
Organ Details
Pancreatic parenchyma
Pancreatic duct
Common bile duct
Measuring the pancreatic diameter
Anatomical Relationships
Relationships of the tail of the pancreas
Relationships of the body of the pancreas
Relationships of the head of the pancreas
8 Stomach, Duodenum, and Diaphragm
Organ Details
Stomach wall
Organ Boundaries and Relationships
Esophagus and cardia
Body of the stomach
Antrum and duodenum
Diaphragm
9 Spleen
Organ Boundaries
Locating the spleen
Imaging the entire spleen
Organ Details
Shape of the spleen
Determining the size of the spleen
Echo pattern
Anatomical Relationships
Relationship of the spleen to the pancreas, kidney, colic flexure, and
stomach
Relationship of the spleen to the pleura
10 Kidneys
Organ Boundaries
Locating the right kidney
Imaging the entire right kidney
Locating the left kidney
Imaging the entire left kidney
Organ Details
Size and shape of the kidneys
Renal parenchyma and renal sinus
Anatomical Relationships of the Right Kidney
Relationship of the right kidney to the liver
Relationship of the right kidney to the psoas and quadratus lumborum
muscles
Relationship of the right kidney to the colon
Relationship of the right kidney to the gallbladder
Anatomical Relationships of the Left Kidney
Relationship of the left kidney to the spleen
Relationship of the left kidney to the psoas and quadratus lumborum
muscles
Relationship of the left kidney to the colon
11 Adrenal Glands
Organ Boundaries and Anatomical Relationships
Ultrasound morphology of the adrenal glands
Location of the adrenal glands
Right adrenal gland
Left adrenal gland
Organ Details
Abnormalities of the adrenal glands
12 Bladder, Prostate, and Uterus
Organ Boundaries and Relations
Bladder and prostate
Bladder and uterus
Organ Details
Prostate
Uterus
13 The Systematic Ultrasound Examination
Topographic Units
Liver
Gallbladder and porta hepatis
Right kidney
Left kidney and spleen
Epigastrium and pancreas
Midabdomen
Lower abdomen
Description of Findings and Nomenclature
Documentation
Written report
Image documentation
14 The Sono Consultant
I Ultrasound Findings
1. Aorta: Widening
2. Vena cava: Dilatation
3. Liver: Large
4. Liver: Small
5. Liver: Increased echogenicity
6. Liver: Hepatic veins dilated
7. Liver: Circumscribed mass
8. Liver: Echo-free mass
9. Liver: Hypoechoic mass
10. Liver: Isoechoic or hyperechoic mass
11. Liver: Hyperechoic mass with an acoustic shadow
12. Ascites
13. Gallbladder: Stone
14. Gallbladder: Circumscribed wall changes
15. Gallbladder: Thickened wall
16. Gallbladder: Large
17. Gallbladder: Echogenic contents
18. Gallbladder: Acoustic shadowing
19. Common duct: Dilatation
20. Pancreas: Dilated duct
21. Pancreas: Cannot be identified
22. Pancreas: Increased echogenicity
