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INDEX 279 Continuous ambulatory peritoneal dialysis (CAPD), 181–2 Contracted gallbladder, 49–50, 50 Contrast agents, 266–8, 268, 269 Contrast sonocystography, 229 Cortical scintigraphy, 229 Cranial index (TIC), 11 Crohn’s disease, 111, 209, 211, 246 Cryotherapy, 264, 266 Cyst drainage, 262–3 Cystadenocarcinomas, 130, 132 Cystadenomas, 81, 81 Cystic disease, 160–2 Cystic duct, 49 Cystic duct obstruction, 48, 50 Cystic fibrosis (CF) changes in liver reflectivity, 111 cholestasis, 218 cysts, 134 gallstones, 50 general information, 216 increased echogenicity, 221 microgallbladder, 51 ultrasound appearances, 109, 109, 217 Cystine stones, 171 Cystinuria, 173, 173 Cysts adrenal, 203 choledochal, 218, 219 enteric duplication, 239–40, 240 hepatic, 79–81, 80, 81, 82 hydatid, 82 in children, 221 in obese patients, 4 ovarian, 111 pancreatic, 132, 134, 134 renal, 160–1, 161 splenic, 144, 144 Cytology, 257 D Deep inspiration, 18 Defensive scanning, guidelines for, 13 Departmental guidelines, 13 Design of machines, 7 Dialysis, ultrasound in, 181–2 Diethylene triaminepenta-acetic acid (DTPA) scan, 158, 167 Diffuse liver conditions, 95–110 Dilation PCS, 166 renal, 225–6, 226 renal transplant, 185 Dimer capto succinic acid (DMSA) scan, 223 Dissolution therapy, 48 Diuretic renogram, 229 Diverticulitis, 210, 211, 246 Doppler cirrhosis, 98 correlation, 189 detecting flow, 7 hepatic metastases, 92 kidneys, 248 pancreatitis, 125 sensitivity, 114 spectra, 26 use of, 2–6, 18 using microbubble agents, 267 see also Colour Doppler; Power Doppler Double gallbladder, 31 Drainage, ultrasound-guided, 261–4 Drug-induced liver disease, 96 Drug-induced pancreatitis, 125 Duodenal gas, 63 Duodenum, 30, 32 Duplex kidneys, 158, 159, 221–3, 222, 225 E Echogenic bile, 71–3 Echogenicity, 111, 124, 221 Ectopic gallbladder, 30 Ectopic kidneys, 158, 223 Ectopic pregnancy, 111 Electrical safety, 11 Emphysematous cholecystitis, 58, 60 Empyema, 58, 61 Endocrine tumour, 132 Endometriosis, 167 Endoscopic retrograde cholangiopancreatography (ERCP), 47, 62 Endoscopic ultrasound, 64, 246, 269–71 Endosonography, 210 Enlargement of the gallbladder, 48–9 Enlargement of the spleen, 109, 139, 139, 140, 146 Enteric duplication cysts, 239–40, 240 Epigastrium, 28, 29, 208 Equipment for biopsy, 255, 256–7 Equipment tests, 14–15 Ergonomics of machines, 8 European Committee for Ultrasound Radiation Safety (ECURS), 10 European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), 10 Extracorporeal shock wave lithotripsy (ESWL), 48 Extrarenal pelvis, 158, 160 F Faeces, impacted, 36 Failure, renal, 111, 177–9 Fasting, 27, 29 Fatty infiltration, 87, 88, 95–7, 96, 111 Fatty sparing, 87, 87–8 Fever, 82–3 Fibrosis, 67, 111 Field, size of, 2 Fine needle aspiration cytology, 257 Fistulae, 209 Flow detection with Doppler, 7 in major vessels, 5–6 velocity waveforms, 6 Fluid collections, transplantation, 186–7 Focal fatty change, 87–8, 87–8, 95 Focal fatty sparing of the pancreas, 133 Focal lesions, 116 Focal liver lesions, 24, 112 Focal nodular hyperplasia, 88, 89, 95, 257 Focal obstruction, 67 Focal pancreatitis, 133–4 Focal zone, 2, 3, 5, 44 Focused Assessment with Sonography for Trauma (FAST), 244 Folded gallbladder, 29, 30, 31 Fracture, pancreatic, 246 Frame rate, 2, 3, 5 Free fluid detection, 244, 245 Free intraperitoneal fluid, 111 Freehand biopsy, 255 Frequency changing, 2 increasing the, 1, 5 range of, 7 settings for gallbladder, 2, 27, 30 Fundamental imaging mode, 4 Fungal balls, 167, 191, 229, 230 Fungal infections, 229 G Gallbladder biliary dilation without jaundice, 66–7
280 INDEX Gallbladder (Continued) blood in the, 72 carcinoma, 50, 73, 73 cholecystitis (see Main entry) cholelithiasis, 41–8 contracted or small, 49–50, 50 double, 31 drainage of, 262 echogenic bile, 71–3 ectopic, 30 enlargement of the, 48–9 folded, 29, 30, 31 frequency settings for, 2, 5, 27, 30 full abdominal survey, 17 hyperplastic conditions of the wall, 51–4 in children, 216 in the obese patient, 4 inflammatory gallbladder disease, 54–8 introduction, 27–9 malignant biliary disease, 73–6 metastases, 76 microgallbladder, 50, 51, 216, 217 mucocoele, 48 normal variants of the, 29 obstruction without biliary dilation, 67 obstructive jaundice and biliary duct dilation, 58–66 other biliary diseases, 67–71 pitfalls in scanning the, 29–31 polyps, 28 porcelain, 50, 51 removal (see Cholecystectomy) septum, 29 stones (see Gallstones) strawberry, 53–4, 54 ultrasound appearances, 31, 32 Gallstones abdominal pain, 36, 248 chronic cholecystitis, 56 clinical features, 41–2 gallstone pancreatitis, 47, 246 general information, 42–5 in the common bile duct, 45–7 small gallbladder, 50 ultrasound appearances, 42, 51 Gangrenous cholecystitis, 57–8, 59 Gas, bowel, 29, 63, 212, 223 Gastric carcinoma, 208 Gastrinomas, 128 Gastro-oesophageal reflux, 238 Gastrointestinal tract acute presentations of, 245–6 appendix, 206–7 inflammatory bowel conditions, 209–10 malignant tumours, 210 mesenteric ischaemia, 207–9 obstruction, 211 oesophagus and stomach, 206 paediatric, 232–40 Gilbert’s disease, 96 Glomerulonephritis, 178–9 Glycogen storage disease, 99 Granulomatas, 88, 90, 95, 146 Guidance, biopsy, 255 Guidelines, departmental, 13 H Haemangioblastomas, 134 Haemangioendotheliomas, 220 Haemangiomas, 3, 85–6, 85–6, 95, 145 Haemangiomatas, 219 Haematomas complications of biopsy, 258, 261 hepatic, 84, 84–5, 96, 116 psoas, 250, 250 renal, 187 subcapsular, 245 subphrenic, 117 Haematuria, 182 Haemo-hydronephrosis, 168–9 Haemobilia, 72 Haemochromatosis, 99, 221 Haemodynamics, 25–7, 155–6 Haemolysis, 96 Haemolytic anaemia, 139, 146 Haemorrhage, 232, 233, 248, 261 Haemorrhagic tumour, 132 Harmful effects of ultrasound, 10–12 HELLP syndrome, 109–10, 110 Hepatic see Liver Hepatitis, 106–7, 107, 111, 139, 216, 257 Hepatobiliary system bile ducts, 31–3 common referral patterns, 33–6 gallbladder, 27–31 hepatobiliary emergencies, 246–8 hepatobiliary pathology: paediatric abdomen, 216–20 introduction, 17–18 liver, 18–27 upper-abdominal anatomy, 36–9 upper-abdominal technique, 18 see also Bile ducts; Liver Hepatoblastomas, 218–20, 219, 234 Hepatocellular carcinoma (HCC) biopsy procedures, 257 general information, 93–5 hepatobiliary pathology, 218–20 in a patient with cirrhosis, 94, 95, 98 treatment of, 269 viral hepatitis, 106 Hepatomas, 261 Hepatomegaly, 220 Hippel–Lindau disease, 134 Hodgkin’s lymphoma, 139, 165 Horseshoe kidneys, 158, 159, 223, 223 Hydatid cysts, 82, 82, 177 Hydronephrosis, 168, 168–9, 170, 225–6, 263 Hyperaemia, 54, 56 Hyperparathyroidism, 173–4 Hyperplastic conditions of the gall bladder wall, 51–4 Hypertension, portal see Portal hypertension Hypertrophic pyloric stenosis (HPS), 234, 235 Hypervascularized bowel, 210 Hypotrophied column of Bertin, 158–9 I Image optimization, 1–2 Image quality, 1–2, 7–8 Images, recording of, 9–10 Imaging the paediatric renal tract, 229 Impacted faeces, 36 Impacted gallstones, 45, 45 Incorrect use of equipment, 5 Increasing the frequency, 1 Indirect ultrasound guidance, 263–4 Infarction of the spleen, 146, 147 Infection, renal tract, 174–7, 189 Inferior vena cava (IVC), 199–201, 200, 201 Inflammation gastrointestinal tract, 245–6 renal tract, 174–7 Inflammatory bowel conditions, 209–10 Inflammatory gallbladder disease, 54–8 Inspiration, deep, 18 Inspissated bile, 71, 71 Insulin-dependent diabetes, 135 Insulinomas, 128 Intercostal scanning, 18 Intrahepatic tumours, 64, 67 Intraoperative ultrasound (IOUS), 113, 264, 265
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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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Chapter 7 153 The renal tract CHAPT
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THE RENAL TRACT 155 As with any oth
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THE RENAL TRACT 157 A B q 0 LRA AO
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THE RENAL TRACT 159 junctions of or
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THE RENAL TRACT 161 A B Figure 7.5
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THE RENAL TRACT 163 carcinomas, the
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THE RENAL TRACT 165 the vesicourete
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THE RENAL TRACT 167 Table 7.1 Sourc
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THE RENAL TRACT 169 A B Figure 7.13
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THE RENAL TRACT 171 Table 7.2 Diffe
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THE RENAL TRACT 173 Ultrasound stil
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THE RENAL TRACT 175 CT is useful fo
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THE RENAL TRACT 177 Xanthogranuloma
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THE RENAL TRACT 179 As with acute t
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THE RENAL TRACT 181 der with increa
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THE RENAL TRACT 183 ● ● Morphol
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THE RENAL TRACT 185 ● ● hydrone
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THE RENAL TRACT 187 A Figure 7.27 A
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THE RENAL TRACT 189 vascular reject
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THE RENAL TRACT 191 B A C Figure 7.
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THE RENAL TRACT 193 computerised ul
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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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