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THE RETROPERITONEUM AND GASTROINTESTINAL TRACT 197 C D E F G Figure 8.2 cont’d (C) TS slightly distal to (B). The right renal artery (RRA) is seen arising from the lateral aspect of the aorta; the left renal vein (LRV) passes anteriorly to drain into the inferior vena cava (IVC). (D) A coronal plane, from the patient’s left side, demonstrates the aortic bifurcation. (E) Coronal section of the aorta at the level of the renal arteries (arrows). (F) The Doppler spectrum from the aorta demonstrates a highly pulsatile waveform with reversed flow in early diastole. (G) The aorta of an elderly patient contains calcification in the walls, which causes acoustic shadowing.
198 ABDOMINAL ULTRASOUND For this reason, aortic aneurysms are monitored, and a graft placed within the vessel in aneurysms over 5 cm which are increasing in size. Postoperative complications of grafts, such as infection or pseudoaneurysm, are usually monitored with CT or MRI. Discussions of the benefits of screening programmes for selected populations are ongoing. 1,2 However, there is some evidence that, despite the reduction of mortality due to aneurysm rupture, overall mortality in men over 65 remains unaffected by screening, 3 and it has not been widely adopted into patient management. Most aneurysms are associated with atherosclerosis, which weakens the media of the wall, causing the vessel to dilate and eventually rupture. The aneurysm may be fusiform or saccular (Fig. 8.3). Blood flow within it is turbulent, and the slow-flowing blood at the edges of the vessel tends to thrombose. Surgery is always complicated by the involvement of the renal arteries. Fortunately, the vast majority of aneurysms are infrarenal, but it can be difficult to determine the relationship of the aneurysm to the renal artery origins on ultrasound, and CT is helpful in such cases. The use of angiography can be beneficial in this respect; however its disadvantage is that, unlike ultrasound, it displays only the lumen of the vessel and can underestimate the pathology present. Occasionally the aneurysm affects the bifurcation and common iliac arteries, which should be examined during the scan as far as possible. The true maximum diameter of the aneurysm should be ascertained in TS and LS. A true anteroposterior diameter is most accurately measured in LS, by ensuring the calipers lie in a plane perpendicular to the vessel axis at its widest part. To measure the lateral diameter in TS, care must be taken to keep the angle of the transducer perpendicular to the vessel axis to ensure an accurate and reproducible measurement. The ability of ultrasound to locate the B A C Figure 8.3 (A) LS demonstrating an aneurysm of the lower abdominal aorta. (B) TS through the aneurysm containing thrombus with an eccentric lumen demonstrating turbulent flow. (C) LS demonstrating flow around the thrombus in the aneurysm. (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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Chapter 5 121 The pancreas CHAPTER
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THE PANCREAS 123 the patient’s le
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THE PANCREAS 125 Acute pancreatitis
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THE PANCREAS 127 E F G Figure 5.3 c
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A C DISTANCE = 3.43 CM 5%. 13 Over
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THE PANCREAS 131 G H I Figure 5.5 c
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THE PANCREAS 133 head of pancreas.
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THE PANCREAS 135 pancreatic juice i
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Chapter 6 137 The spleen and lympha
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THE SPLEEN AND LYMPHATIC SYSTEM 139
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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
Page 212 and 213: THE RETROPERITONEUM AND GASTROINTES
Page 228 and 229: Chapter 9 215 The paediatric abdome
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Page 232 and 233: THE PAEDIATRIC ABDOMEN 219 B A B Fi
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Page 254 and 255: THE PAEDIATRIC ABDOMEN 241 system i
Page 256 and 257: Chapter 10 The acute abdomen 243 CH
Page 258 and 259: 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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