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THE NORMAL HEPATOBILIARY SYSTEM 19 Figure 2.1 Longitudinal section (LS) through the right lobe of the liver. The renal cortex is slightly less echogenic than the liver parenchyma. LIVER superior margin of the liver and is best demonstrated when surrounded by ascitic fluid. It surrounds the left main portal vein and is known as the ligamentum teres as it descends towards the infero-anterior aspect of the liver (Figs 2.9 and 2.15). The ligamentum venosum separates the caudate lobe from the rest of the liver (Fig. 2.6). The size of the liver is difficult to quantify, as there is such a large variation in shape between normal subjects and direct measurements are notoriously inaccurate. Size is therefore usually assessed subjectively. Look particularly at the inferior margin of the right lobe which should come to a point anterior to the lower pole of the right kidney (Fig. 2.1). A relatively common variant of this is the Reidel’s lobe, an inferior elongation of segment VI Figure 2.2 The capsule of the liver (arrows) is demonstrated with a high-frequency (7.5 MHz) probe. on the right. This is an extension of the right lobe over the lower pole of the kidney, with a rounded margin (Fig. 2.16), and is worth remembering as a possible cause of a palpable right upper quadrant ‘mass’. To distinguish mild enlargement from a Reidel’s lobe, look at the left lobe. If this also looks bulky, with a rounded inferior edge, the liver is enlarged. A Reidel’s lobe is usually accompanied by a smaller, less accessible left lobe. Right lobe of liver Branch of RPV Morrison’s pouch Right kidney Quadratus lumborum Branch of RHV A Figure 2.3 B Diaphragm LS through the right lobe of the liver and right kidney. RPV = right portal vein; RHV = right hepatic vein.
20 ABDOMINAL ULTRASOUND Right lobe of liver Right adrenal Medial aspect right kidney A Figure 2.4 B LS, right lobe, just medial to the right kidney. Diaphragmatic crus Right lobe of liver RPV IVC RRA A Figure 2.5 B LS, right lobe, angled medially towards the inferior vena cava (IVC). RRA = right renal artery. Crus Left lobe of liver LPV Ligamentum venosum Stomach HA Head of pancreas Splenic vein IVC A Figure 2.6 artery. Caudate lobe B LS, midline, through the left lobe, angled right towards the IVC. LPV = left portal vein; HA = hepatic
Page 2 and 3: Abdominal Ultrasound
Page 4 and 5: Abdominal Ultrasound How, Why and W
Page 6 and 7: v Contents Contributors Preface ix
Page 8 and 9: vii Contributors Rosemary Arthur FR
Page 10 and 11: ix Preface Ultrasound continues to
Page 12 and 13: ABBREVIATIONS xi MHA MHV MI MPV MRA
Page 14 and 15: Chapter 1 1 Optimizing the diagnost
Page 16 and 17: OPTIMIZING THE DIAGNOSTIC INFORMATI
Page 30 and 31: Chapter 2 17 The normal hepatobilia
Page 34 and 35: THE NORMAL HEPATOBILIARY SYSTEM 21
Page 54 and 55: Chapter 3 41 Pathology of the gallb
Page 56 and 57: PATHOLOGY OF THE GALLBLADDER AND BI
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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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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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