Table Of ContentSurgical Ultrasound
Ren(cid:2) Mantke, MD Ulrich Peitz, MD
OttovonGuerickeUniversity DepartmentofInternal
ChairmanoftheDepartment MedicineGastroenterology
ofGeneralandGastrointestinal Raphaelsklinik
Surgery Muenster,Germany
CityMedicalCenter
Brandenburg,Germany
Withcontributionsby
VolkerAumann Ren(cid:2)Mantke
ThomasBuerger JohannesMayr
ChristianGoerg HarryRudolfMerk
WolfgangGrechenig G(cid:2)zaPap
ReinhartGrote UlrichPeitz
GeroldKaiper WolfgangPichler
JuergenKleinstein MatthiasPross
HardyKrause KirstenReschke
HaukeLang JoergC.Schlegel
HendrikLehnert HansUlrichSchulz
HansLippert AntjeWeimann
RainerLueck ArvedWeimann
HelmutMadjar Hans-PeterWeskott
KonradMahlfeld UweWill
ThomasManger EikeWrenger
957illustrations
GeorgThiemeVerlag
Stuttgart·NewYork
IV
LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscienceun-
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This book is an authorized and revised translation of the readersmayrestassuredthattheauthors,editors,andpub-
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areeitherrarelyusedorhavebeennewlyreleasedonthe
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errorsinthisworkarefoundafterpublication,erratawillbe
Translator:DietrichHerrmann,Hameln,Germany posted at www.thieme.com on the product description
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V
Dedicated toHansLippert
on theoccasion of his 60thbirthday.
ProfessorLippertisDirectoroftheClinicofGeneral,Visceral,andVascularSurgery
attheOttovonGuerickeUniversityHospitalinMagdeburg,Germany.
VI
Foreword
Modernmedicineischaracterizedbyahighdegreeofspe- For many years, Dr Mantke and Dr Peitz have been
cializationontheonehandandbyproblem-orientedmulti- promulgating excellent knowledge of ultrasound and ex-
disciplinarycooperationontheother.Inthemedicalfield, tensiveexperiencein the teachingof sonographic techni-
this concentration of expertise from different authorities, ques.Withthisbooktheyhavesucceededinelaboratinga
whichappliestodiagnosticaswellastotherapeuticman- systematicpresentationofultrasoundapplicationsinsurgi-
agement,isarathernewwayofapproachingaproblem. caldisciplines.Awiderangeofexcellentimagingmaterial
Evaluation of the real-time image by the physician in illustrates the theoretical basic knowledge and certainly
charge and the possibility of repeating the examination benefitsthereader.
withoutendangeringorstrainingthepatientrenderultra- Wehopeandexpectthatthiscooperativeworkwillfind
sonographyaparticularlyattractiveinvestigation. readyacceptanceinmedicalpractice.
Preoperative, intraoperative, postoperative, and inter-
ventionalapplicationhaspromotedthisuniversallyavail- HansLippert,MD
ablemethodtoanintegralcomponentofthephysicalex- Professor
amination in many disciplines in which the ultrasound HeadoftheClinicalDepartment
machinehasgainedaroleequivalenttothatofthestetho- ofGeneral,Visceral,andVascularSurgery
scope. OttovonGuerickeUniversity
Specific qualifications and ongoing training are indis- Magdeburg,Germany
pensableinorderthatexperienceaswellastechnicalinno-
vationswillflowintothediagnosticcycle. P.Malfertheiner,MD
Weareaccordinglysupportingourcolleaguesinthesys- Professor
tematic constitution of ultrasound in our specialty. All HeadoftheClinicalDepartment
physiciansshouldacquirethecompetencetoperformsono- ofGastroenterologyandHepatology
graphicexaminationsinthesphereoftheirspecialtysothat OttovonGuerickeUniversity
theycanuseultrasoundasabasicdiagnostictool. Magdeburg,Germany
VII
Preface
Many readers may ask “Why yet another book on ultra- amicandthree-dimensionalreconstructionsarepromising
sound?”Theanswerappearsobvioustous:anup-to-date toamplifydiagnosticpossibilitiesconsiderably.
teachingbookonultrasound,comprehensiveandyetcom- Theintentionofthisbookistopresentsurgicallyrele-
pact,orientedtowardthesurgicalspecialtiesandfocusing vantknowledgeofsonographyinaquicklycomprehensible
onthemajortopicsinsurgeryisindemand.Therankingof andpracticallyorientedform.Forthispurpose,allsections
ultrasoundamongthe investigationsfor surgicaldiseases havebeenuniformlydividedintothreeunitsconsistingof
hasbeensteadilyrising.Thereasonsareahighdiagnostic “Relevant Basic Information,” “Sonographic Criteria,” and
yieldinthefirstline,combinedwithavailabilityatalmost “ConsequencesforSurgicalTreatment.”Theexistingguide-
anytimeandplace,lackofrisks,andlowcost. linesoftheGermanAssociationofSurgeryhavebeeninte-
Establishingdiagnosesofsurgicaldiseasesanddeciding gratedintothecorrespondingchapters.
onindicationsforsurgicalinterventionsaretasksinherent Despiteallestablishedsurgicalstandards,everypatient
tothedutiesofthesurgeon,whichheorsheoftenfulfillsin requiresindividual therapeutic decisions. Taking this into
cooperationwithcolleaguesfromrelatednonsurgicaldisci- account,anybookcanonlybeusedforbasicguidance.The
plines.Thecooperativeconceptisreflectedintheselection knowledgeimpartedisfoundedonnumerouspublications,
oftheco-authorsforthisbook.Amajorpartofthetexthas the most important of which are listed at the end of the
arisenfrominterdisciplinarycooperationbetweensurgeons book toenable the reader togain deeper insightinto the
and,forexample,endocrinologists,gastroenterologists,gy- matter.
necologists, orthopedists, and urologists. In most surgical Interpretationofstaticultrasoundimages proves diffi-
pathologies,sonographictechniquescanmakesubstantial cultfortheunskilledobserver.Forthisreason,eachphoto-
contributionsalongthediagnosticpathway.Thisappliesin graphhasbeenaccompaniedbyanexplanatoryschematic
particulartosurgicalemergencies,whereultrasoundproves drawing.Sonographydoes,however,provideandthriveon
valuable,forexample,intheassessmentofbluntabdominal movingpictures,renderedpossiblebytheprocessofreal-
traumaandofbowelobstruction,andinthediagnosticcon- timeimaging.Thedynamicsresultononehandfromthe
firmationoreliminationofcardiactamponadeandofpleural examination course itself, with free selection of imaging
effusions. The debate about which clinical medical disci- planes,ontheotherfromtheregistrationofmobilebody
plinesshouldandmaypracticediagnosticultrasoundthat functions,inparticularofthebloodflow.Becauseofthese
hasbeengoingonforyearshasinfactlongbeendecidedby dynamicconditions,thelearningofsonography—examina-
thereality:thepersonwhoisinchargeofthepatientper- tiontechniqueaswellasimageandsoundinterpretation—
formsthesonographicexamination.Ofcoursethatperson requiresmultiplepracticalexercisesundertheguidanceof
willaskforguidanceandhelpfromthemostexperienced a colleague qualified for training. Practical skills are ac-
colleaguefromhisorherinstitution. quiredduringdailyworkaswellasfromthecoursesofsur-
For good reasons, sonographic diagnostic techniques gical and radiological colleges. This book has been con-
havebeenincorporatedintothelogbookofthegeneralsur- ceivedtoprovidethenecessarytheoreticalfoundationfor
gical trainee and into specialized surgical training pro- theresidentandfellowintrainingasmuchasforthequali-
grams.Inthesameway,theformationofasurgicalsection fiedsurgeon.
oftheGermanSocietyofUltrasoundinMedicine(Deutsche WeareparticularlyindebtedtotheDirectorsofourDe-
Gesellschaftf(cid:3)rUltraschallinderMedizin[DEGUM])and partments, Professor H. Lippert and Professor P. Malfer-
thefoundationofaSurgicalWorkingGroupforEndoscopy theiner,withoutwhosehelpandgeneroussupportthein-
and Ultrasound (Chirurgische Arbeitsgemeinschaft Endo- vestmentoftimewouldnothavebeentolerable,asmuch
skopieundUltraschall[CAE])withintheGermanAssocia- as to our wives Marita Mantke and Lucia Clara Peitz and
tionofSurgeryunderlinetheimportanceofsonographicex- our children, who had to sacrifice many night and week-
aminationsinthesurgicalfield. endhourswiththeirhusbandsandfathers.Wealsoexpress
UltrasoundmachinesforB-modeandDopplersonogra- our gratitude to Thomas Scherb MD, Marion Ueckert,
phyarenowadays availableineverysurgicalhospitalde- SusanneRistea,andClaudiaG(cid:3)nerfortheGermanedition,
partmentandinmanyoutpatientclinicsandsurgeries.Col- toCliffordBergman,AnnieHollins,andDietrichHerrmann
orDopplerultrasoundanditsrefinements,suchaspower fortheEnglishedition,andtotheentireteamoftheThieme
Dopplerultrasound,arefrequentlyalsopresentorarebeing publishinggroupfortheirexcellentprofessionalsupport.
sharedbymembersofdifferentdisciplines.Miniaturization Finally, we apologize foranyerrors that mightremain
ofultrasoundcomputershasmadepossibletheconstruc- despitethemostcarefulproofreading,andwewouldsin-
tionofportablemachinesthatcanbeusedatthepatient(cid:5)s cerelyappreciateanyconstructivecriticalcommentonthis
bedside,intheemergencyroom,oratthesiteofanacci- book.
dent. Newer technicaldevelopmentslike tissue harmonic
imagingandcontrastharmonicimagingaswellaspanor- Ren(cid:2)Mantke,UlrichPeitz
VIII
Contributors
VolkerAumann,MD HaukeLang,MD,FACS Ren(cid:2)Mantke,MD
DepartmentofPediatrics DepartmentofGeneraland AssociateProfessor
UniversityHospital TransplantationSurgery OttovonGuerickeUniversity
Magdeburg,Germany UniversityofEssen Magdeburg,Germany
Essen,Germany ChairmanoftheDepartmentof
ThomasBuerger,MD GeneralandGastrointestinalSurgery
AssociateProfessor HendrikLehnert,MD,FRCP CityMedicalCenterBrandenburg
OttovonGuerickeUniversity Professor Brandenburg,Germany
DepartmentofGeneral,Abdominal, ChairofMedicine
andVascularSurgery WarwickMedicalSchool JohannesMayr,MD
UniversityHospital CoventryUniversityHospital Professor
Magdeburg,Germany Coventry,UnitedKingdom DepartmentofPediatricSurgery
UniversityofBasel
ChristianGoerg,MD HansLippert,MD Basel,Switzerland
Professor ProfessorofSurgery
PhilippsUniversity HeadofDepartmentofGeneral, HarryRudolfMerk,MD,MSc
DepartmentofInternalMedicine Abdominal,andVascularSurgery DepartmentofOrthopedics
Marburg,Germany UniversityHospital ErnstMoritzArndtUniversity
Magdeburg,Germany Greifswald,Germany
WolfgangGrechenig,MD
ProfessorofTraumatology RainerLueck,MD G(cid:2)zaPap,MD
UniversityClinicofTraumatology DepartmentofAbdominaland DepartmentofOrthopedics
Graz,Austria TransplantationSurgery OttovonGuerickeUniversity
HanoverMedicalSchool Magdeburg,Germany
ReinhardGrote,MD Hanover,Germany
Professor UlrichPeitz,MD
DepartmentofRadiology HelmutMadjar,MD AssociateProfessor
CityHospitalMagdeburgOlvenstedt DepartmentofGynecology DepartmentofInternalMedicine
Magdeburg,Germany ProfessorandChairman Gastroenterology
GermanDiagnosticClinic Raphaelsklinik
GeroldKaiper,MD Wiesbaden,Germany Muenster,Germany
OttovonGuerickeUniversity
DepartmentofUrology KonradMahlfeld,MD WolfgangPichler,MD
UniversityHospital DepartmentofOrthopedics UniversityClinicofTraumatology
Magdeburg,Germany OttovonGuerickeUniversity Graz,Austria
Magdeburg,Germany
JuergenKleinstein,MD MatthiasPross,MD
Professor ThomasManger,MD AssociateProfessor
ClinicforReproductiveMedicineand Professor DepartmentofSurgery
GynecologyEndocrinology DepartmentofGeneral,Visceral, DRKKlinikenBerlin/Koepenick
OttovonGuerickeUniversity andPediatricSurgery Berlin,Germany
Magdeburg,Germany SRHWaldHospitalGeraGmbH
AcademicHospitaloftheFriedrich KirstenReschke,MD
HardyKrause,MD SchillerUniversityJena OttovonGuerickeUniversity
DivisionofPediatricSurgery Gera,Germany DepartmentofEndocrinologyand
DepartmentofGeneral,Abdominal, Metabolism
andVascularSurgery Magdeburg,Germany
UniversityHospital
Magdeburg,Germany
Contributors IX
JoergC.Schlegel,PhD AntjeWeimann,MD Hans-PeterWeskott,MD
MarketingManager TransplantationOutpatientClinic DepartmentofUltrasound
UltrasoundBusinessGroup DepartmentofAbdominal,Transplan- KlinikumRegionHannover
ToshibaMedicalSystemsEuropeBV tation,Vascular,andChestSurgery SiloahGeneralHospital
HeadOffice UniversityofLeipzig Hanover,Germany
Zoetermeer,Netherlands Leipzig,Germany
UweWill,MD
HansUlrichSchulz,MD ArvedWeimann,MD DepartmentofInternalMedicineIII
ProfessorofSurgery HeadofDepartmentofGeneraland MunicipalHospital
DepartmentofGeneral,Abdominal, AbdominalSurgery Gera,Germany
andVascularSurgery St.GeorgeHospital
UniversityHospital AffiliatedHospitalofthe EikeWrenger,MD
Magdeburg,Germany UniversityofLeipzig CenterforNephrologyandDialysis
Leipzig,Germany Langenhagen(Hanover),Germany
