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THE RETROPERITONEUM AND GASTROINTESTINAL TRACT 201 F G Figure 8.4 cont’d (F) Normal, pulsatile spectrum from the proximal IVC is influenced by the proximity of the right atrium. (G) The waveform from the distal IVC is lower in velocity, less pulsatile and displays more variance. enters the IVC in around 10% of renal carcinoma cases. Tumour thrombus from hepatic or adrenal masses can also invade the IVC. Coagulation disorders, which cause Budd– Chiari syndrome (see Chapter 4) predominantly affect the hepatic veins, but may also involve the IVC (Fig. 8.5). Patients may require the insertion of a caval filter, which is performed under X-ray guidance, but may be monitored for patency using ultrasound with Doppler. Dilatation of the IVC is a finding commonly associated with congestive heart failure, and is frequently accompanied by hepatic vein dilatation. Compression of the IVC by large masses is not uncommon. This may be due to retroperitoneal masses, such as a large lymph node, or liver masses such as tumour or caudate lobe hypertrophy. Colour or power Doppler is particularly useful in confirming patency of the vessel and differentiating extrinsic compression from invasion. Insertion of metallic stents may be performed under angiographic control to maintain the vessel patency, particularly if the compression is due to inoperable hepatic metastasis (Fig. 8.6). Tumours of the IVC are rare. Leiomyosarcoma is a primary IVC tumour, appearing as a hyperechoic mass in the lumen of the vein. 4,5 This causes partial or complete obstruction of the IVC, resulting in Budd–Chiari syndrome. In partial occlusion, the hepatic veins and proximal IVC may be considerably dilated. Resection of the tumour, with repair of the IVC, is possible provided the adjacent liver is not invaded. 4 THE ADRENAL GLANDS Normal appearances The normal adrenal glands can be seen on ultrasound in the vast majority of patients, 6,7 if you know where and how to look. Each adrenal gland is constructed with a central fold or ridge, which points anteromedially, from which extend two thin ‘wings’ of tissue—a medial and a lateral wing (Fig. 8.7). The ultrasound appearances are therefore of a < shape in LS, or a thin, linear structure as the transducer is moved medially towards the central ridge. The wings of the gland appear hypoechoic and are no more than 2 mm in thickness. Ultrasound technique For the right adrenal, use the liver as an acoustic window. Scan the upper pole of the kidney intercostally through the liver, and angle slightly medially to the kidney, where the gland can be located between the liver and the diaphragmatic crus (Fig. 8.7A). Continue angling slightly medially towards the IVC and the central ridge of the gland is seen behind the IVC (Fig. 8.7B). For the left gland the spleen must be used as a window. To avoid overlying bowel this is best achieved with the patient supine, using a coronal section. When the upper pole of the left kidney is located through the spleen, the left adrenal can be seen in the small triangular area between the spleen, kidney and diaphragmatic crus (Fig. 8.7D). 6,7
202 ABDOMINAL ULTRASOUND IVC_ IVC B A M L R C D Figure 8.5 (A) Tumour thrombus from a left renal carcinoma completely occludes the IVC (arrows). Liver metastases are also present. (B) Advanced renal carcinoma. The IVC is full of tumour. (A hyperechoic liver metastasis is also seen on the left.) (C) TS through the IVC containing thrombus. This is the result of proximal compression of the IVC by a large liver abscess. (D) Tumour thrombus from a renal carcinoma has spread up the IVC and invaded the right hepatic vein (RHV), causing a partial Budd–Chiari effect.
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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 164 and 165: THE SPLEEN AND LYMPHATIC SYSTEM 151
Page 166 and 167: Chapter 7 153 The renal tract CHAPT
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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
Page 188 and 189: THE RENAL TRACT 175 CT is useful fo
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 210 and 211: THE RETROPERITONEUM AND GASTROINTES
Page 228 and 229: Chapter 9 215 The paediatric abdome
Page 230 and 231: THE PAEDIATRIC ABDOMEN 217 A B SPLE
Page 232 and 233: THE PAEDIATRIC ABDOMEN 219 B A B Fi
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Page 238 and 239: THE PAEDIATRIC ABDOMEN 225 + 78 A 2
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Page 242 and 243: THE PAEDIATRIC ABDOMEN 229 Table 9.
Page 244 and 245: THE PAEDIATRIC ABDOMEN 231 A LT B C
Page 250 and 251: THE PAEDIATRIC ABDOMEN 237 mesenter
Page 252 and 253: THE PAEDIATRIC ABDOMEN 239 E F G Fi
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
Page 260 and 261: THE ACUTE ABDOMEN 247 LIVER LS GB S
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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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