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THE SPLEEN AND LYMPHATIC SYSTEM 147 A B C D Figure 6.8 (A) Splenic infarct due to an embolus following recent liver resection. (B) Colour Doppler of the same patient demonstrates a lack of perfusion in the infarcted area. (C) CT scan of the same patient. (D) Complete splenic infarction. The spleen is small and hyperechoic. Considerable free fluid is present. The most common of these are pancreatitis and tumour thrombus. Colour and spectral Doppler are an invaluable aid to the diagnosis, particularly when the thrombus is fresh and therefore echopoor. Contrast agents may be administered if doubt exists over vessel patency. Splenic vein occlusion causes splenomegaly and varices may be identified around the splenic hilum. Splenic artery aneurysm These are rare, although more common than hepatic artery aneurysms. They are only clinically significant if over 2 cm in diameter, when the risk of rupture and fatal haemorrhage is present. Colour and spectral Doppler confirm arterial flow through the aneurysm and help to differentiate it
148 ABDOMINAL ULTRASOUND from other possible cystic masses near the splenic hilum, such as pancreatic pseudocysts. They are usually asymptomatic and are associated with pregnancy or liver disease with portal hypertension. Surgical resection or ligation is performed to prevent rupture, although smaller aneurysms may be safely monitored with ultrasound. 12 Pseudoaneurysm Pseudoaneurysm in the spleen occurs in a minority of cases following splenic trauma. An echo-free or ‘cystic’ area may be observed, which demonstrates flow on colour Doppler. In rare cases, pseudoaneurysm is also a complication of splenic infarct, inflitration of the spleen by malignancy, inflammatory disease such as pancreatitis, or infection 13 and usually occurs in association with non-traumatic splenic rupture. normal lymph nodes can be demonstrated in the hepatoduodenal ligament at the porta hepatis (Fig. 6.9A), particularly in younger patients. 14 The search for lymphadenopathy should include the para-aortic and paracaval regions, the splanchnic vessels and epigastric regions, and the renal hila (Fig. 6.9). Ultrasound has a low sensitivity for demonstrating lymphadenopathy, in the retroperi- Splenic trauma (See also Chapter 10.) Splenic laceration may be particularly difficult to detect on ultrasound, particularly in the immediate post-trauma phase. The presence of free fluid in the abdomen of a trauma victim should alert the sonographer to the strong possibility of organ injury. The laceration may appear as a subtle, hyperechoic line within the spleen immediately after the injury. A frank area of haemorrhage, easily identifiable on ultrasound, may not develop until later. CT is normally performed following the identification of free fluid on ultrasound in order to assess the extent of organ injury. Intrasplenic pseudoaneurysm is a recognized, but rare complication of splenic trauma, which can be demonstrated on colour Doppler. In rare cases, spontaneous splenic rupture may be encountered, most usually associated with massive splenomegaly of the sort seen in infectious mononucleosis. A PORTA GB IVC s LYMPHATICS Traditionally, normal lymph nodes are difficult or impossible to demonstrate on ultrasound. However, with good-resolution equipment, and using a suitable acoustic window, such as normal liver tissue, B Figure 6.9 (A) Normal lymph nodes at the porta. (B) Lymphadenopathy in the epigastrium (arrows) can be seen anterior to the inferior vena cava (IVC). (Continued)
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Abdominal Ultrasound
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Abdominal Ultrasound How, Why and W
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v Contents Contributors Preface ix
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vii Contributors Rosemary Arthur FR
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ix Preface Ultrasound continues to
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ABBREVIATIONS xi MHA MHV MI MPV MRA
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Chapter 1 1 Optimizing the diagnost
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OPTIMIZING THE DIAGNOSTIC INFORMATI
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Chapter 2 17 The normal hepatobilia
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THE NORMAL HEPATOBILIARY SYSTEM 19
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Chapter 3 41 Pathology of the gallb
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PATHOLOGY OF THE GALLBLADDER AND BI
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Chapter 4 79 Pathology of the liver
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PATHOLOGY OF THE LIVER AND PORTAL V
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Page 110 and 111: PATHOLOGY OF THE LIVER AND PORTAL V
Page 134 and 135: Chapter 5 121 The pancreas CHAPTER
Page 136 and 137: THE PANCREAS 123 the patient’s le
Page 138 and 139: THE PANCREAS 125 Acute pancreatitis
Page 140 and 141: THE PANCREAS 127 E F G Figure 5.3 c
Page 142 and 143: A C DISTANCE = 3.43 CM 5%. 13 Over
Page 144 and 145: THE PANCREAS 131 G H I Figure 5.5 c
Page 146 and 147: THE PANCREAS 133 head of pancreas.
Page 148 and 149: THE PANCREAS 135 pancreatic juice i
Page 150 and 151: Chapter 6 137 The spleen and lympha
Page 152 and 153: THE SPLEEN AND LYMPHATIC SYSTEM 139
Page 166 and 167: Chapter 7 153 The renal tract CHAPT
Page 168 and 169: THE RENAL TRACT 155 As with any oth
Page 170 and 171: THE RENAL TRACT 157 A B q 0 LRA AO
Page 172 and 173: THE RENAL TRACT 159 junctions of or
Page 174 and 175: THE RENAL TRACT 161 A B Figure 7.5
Page 176 and 177: THE RENAL TRACT 163 carcinomas, the
Page 178 and 179: THE RENAL TRACT 165 the vesicourete
Page 180 and 181: THE RENAL TRACT 167 Table 7.1 Sourc
Page 182 and 183: THE RENAL TRACT 169 A B Figure 7.13
Page 184 and 185: THE RENAL TRACT 171 Table 7.2 Diffe
Page 186 and 187: THE RENAL TRACT 173 Ultrasound stil
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Page 190 and 191: THE RENAL TRACT 177 Xanthogranuloma
Page 192 and 193: THE RENAL TRACT 179 As with acute t
Page 194 and 195: THE RENAL TRACT 181 der with increa
Page 196 and 197: THE RENAL TRACT 183 ● ● Morphol
Page 198 and 199: THE RENAL TRACT 185 ● ● hydrone
Page 200 and 201: THE RENAL TRACT 187 A Figure 7.27 A
Page 202 and 203: THE RENAL TRACT 189 vascular reject
Page 204 and 205: THE RENAL TRACT 191 B A C Figure 7.
Page 206 and 207: THE RENAL TRACT 193 computerised ul
Page 208 and 209: Chapter 8 195 The retroperitoneum a
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THE RETROPERITONEUM AND GASTROINTES
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Chapter 9 215 The paediatric abdome
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THE PAEDIATRIC ABDOMEN 217 A B SPLE
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THE PAEDIATRIC ABDOMEN 219 B A B Fi
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THE PAEDIATRIC ABDOMEN 221 probe de
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THE PAEDIATRIC ABDOMEN 223 When the
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THE PAEDIATRIC ABDOMEN 225 + 78 A 2
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THE PAEDIATRIC ABDOMEN 227 A B C D
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THE PAEDIATRIC ABDOMEN 229 Table 9.
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THE PAEDIATRIC ABDOMEN 231 A LT B C
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THE PAEDIATRIC ABDOMEN 237 mesenter
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THE PAEDIATRIC ABDOMEN 239 E F G Fi
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THE PAEDIATRIC ABDOMEN 241 system i
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Chapter 10 The acute abdomen 243 CH
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THE ACUTE ABDOMEN 245 scan of the p
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THE ACUTE ABDOMEN 247 LIVER LS GB S
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THE ACUTE ABDOMEN 249 D A RT B C E
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THE ACUTE ABDOMEN 251 17. Patlas M,
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Chapter 11 253 Interventional and o
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INTERVENTIONAL AND OTHER TECHNIQUES
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275 Bibliography and further readin
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277 Index A Abdomen, acute gastroin
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INDEX 279 Continuous ambulatory per
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INDEX 281 Intravenous urography (IV
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INDEX 283 Phrygian cap, 29 Pneumobi
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