Ultrasound Testing.

Ultrasound Testing.
Investigative more than Diagnostic.
A Preliminary step prior to more intrusive and/or expensive procedures.

INDEX

Benefits of Ultrasound Diagnostics.
Products: Ultrasound-Equipment.
-Listing- : Private Clinics in B.C.
Schedule: Services, Fees.

ARTICLES:
Article: How to Read an Ultrasound Picture.
-Basics: How to read an ultrasound image.
-Video-: Abdominal Ultrasound (Sonography), Mark Guenin, M.D.
Article: Sonographic Mimics of Renal Calculi.

Instructional:
Video: Transcription CAUTION.
Video: Landmarks, Abdominal: Location & View of organs.
Video: Part 01 - Abdominal Ultrasonography in Small Animals.
Video: Part 02 - Abdominal, Small Animals, Biliary Tract.
Video: Part 03 - Abdominal, Small Animals, Pancreas.
Video: Part 04 - Abdominal, Small Animals, The Spleen.
Video: Part 05 - Abdominal, Small Animals, Gastro-Intestinal Tract.
Video: Part 06 - Abdominal, Small Animals, Adrenal Glands.
Video: Part 07 - Abdominal, Small Animals, Kidneys.
Video: Part 08 - Abdominal, Small Animals, Bladder.
Video: Part 10 - Abdominal, Male Reproductive.

Video: Pitfalls in Abdominal Ultrasound Diagnostics.
Video: Abdomen, Cardiac, Apical View.
Photo: Abdomen, Aorta, dopwave17.
Photo: Abdomen, Liver, abd-us-liver.
Video: Abdomen, Liver Ultrasound Anatomy.
.

Glossary of Common Medical Terms. URLs
Resources Offline: Articles, PDF reports, Photos, Videos.

-Focus-: Monographs on Toxins and Enhancers.

Benefits of Ultrasound Diagnostics.

Evaluation of all organs ... Changes in size, shape, structure ... presence of nodules or masses.

Generates clear pictures of soft tissues which do not show up well on X-rays.
Non-Invasive, no needles involved, painless.
Widely available, easy-to-use.
Relatively low cost compared to other diagnostics.
No radiation.
Time scan pictures can be provided.
Obstetric ultrasound .. a useful diagnostic tool .. considered to be a safe, non-invasive, accurate and cost effective way of monitoring the development of the growing baby.

Cleft lips and palates, congenital heart abnormalities, Down syndrome, spina bifida and other conditions can be identified at this stage.

Placental abnormalities, the amount of amniotic fluid and other conditions such as ovarian cyst can also be detected in ultrasonography.

Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children.
Point-of-Care Ultrasound is More Accurate than the Stethoscope in Diagnosing Pneumonia in Children.
Ultrasounds could replace radiography for detecting pneumonia in children.
Ultrasound Biofeedback Helps Speech Therapy.

Dangers:

The biggest danger from ultrasound imaging is the over- or under- diagnosing brought about by inadequately trained staff, often working in isolation or using poor equipment.
No definitive diagnosis without fine needle aspirations (FNA) or biopsies.

Products: Ultrasound-Equipment. INDEX
http://www.alibaba.com/Color-Doppler-Ultrasound-Equipments_pid100009344

Verified Supplier - Guangzhou Yueshen Medical Equipment Co., Ltd.
Top 3 Markets: Africa 60.70%, Mid East 18.00%, South America 9.00%
Experience: Established 2003
Min.Order Quantity: 1 Set/Sets ultrasound
Supply Ability: 1000 Set/Sets per Month ultrasound
Port: Guangzhou
Payment Terms: L/C,T/T,Western Union,MoneyGram
(There are many models and sizes of devices on the AliBaba site, $250 to $30,000+)

Ultrasound Scanner YSB0115
http://www.alibaba.com/product-detail/portable-ultrasound_848464976.html
Quick Details Type: Doppler Ultrasound Equipment Brand Name: YSENMED Model Number: YSB0115 Place of Origin: Guangdong China (Mainland) Palmsmart Ultrasound Scanner NO.: YSB0115 Scanning Method: Convex, Micro-convex, Linear, rectal Gray Scale: 256 levels Monitor: 6.4 inch TFT color LCD Image Processio: DFS, DRF, RDA, VGA/DSC and Image Post Procession Packaging Detail: standard export package Delivery Detail: within 15 workdays after payment

Features:
Palmsmart YSB0115, weighting only 1.3KG, is distinguishable by its bright and clear image quality.
The interchangeable probes offer a wide range of diagnostic applications.
This scanner is a cost effective solution for family doctors, veterinary scanning.
The complete software and the high product versatility are available in it.

Technical specifications: ·Scanning Method: Convex, Micro-convex, Linear, rectal ·Display Mode: B, B+B, B+M, M ·Gray Scale: 256 levels ·Monitor: 6.4 inch TFT color LCD ·Image Procession: DFS, DRF, RDA, VGA/DSC and Image Post Procession ·128 frames for cine-memory ·32 image permanent storage ·Image magnification: ×1.0, ×1.2, ×1.5, ×2.0 times ·4 focusing combination selectable ·4 different coded-color available ·15 difference kinds of body marks with difference calipers. ·Measurement in Distance, Circumference/Area, Time/Heart Rate/EF rate for heart, and GS, CRL, BPD, HC, FL, AC for OB/GY measurement, and Gestational Age, Fetal weight, EDD calculation. ·Characteristic showing in real-time clock, ID, Sex, Age, Focusing Info and Gain (Near, Far, Overall) info. ·PAL-D output ·Mouse interface

Probes:
R40/3.5MHz multi-freq convex
Standard configuration:
Main unit + one 3.5MHz convex probe

Listing : Private Clinics in B.C. INDEX
http://www.findprivateclinics.ca/

North Shore Medical Imaging
604 998 1113 --- 604 984 8395 139 West 16th Street Vancouver British Columbia Canada V7M 1T3 Our other location: #110 - 575 16th Street West Vancouver, BC V7V 4Y1 Phone: 604 922 9141 --- Fax: 604 922 6348 email: info@nsmi.ca

False Creek Health Care Centre ... in downtown Vancouver, ...

604-739-9695 --- 604-709-9676 --- 1-800-815-9338 555 W. 8th Ave. 6th floor Vancouver British Columbia Canada V5Z 1C6

North Shore Medical Imaging
North Vancouver 139 West 16th Street Our other location: North Vancouver, BC V7M 1T3 Phone: 604 987 9729 --- Fax: 604 984 8395 --- email: info@nsmi.ca 604 922 9141 --- 604 922 6348 #110 - 575 16th Street Vancouver British Columbia Canada V7V 4Y1

Fraser Valley MRI Clinic
An independent clinic providing MRI services with no wait list and with lowest prices.
Friendly professional staff. Report provided in 2-3 working day ...
604-859-1707 --- 604-859-1747 --- 1-888-788-4MRI

5-2151 McCallum Road Abbotsford British Columbia Canada V2S 3N8

Schedule: Services, Fees. INDEX
http://www.canadadiagnostic.com/info/fees?r=sb
All prices are quoted in Canadian dollars. ...
We accept American Express, MasterCard, Visa or debit cards.
Canada Diagnostic Centres 604-709-8522 Phone: 877-709-8522 Toll Free: 604-709-6112 Fax: info@canadadiagnostic.com

Ultrasound
All exams $500

1.5 Tesla MRI
Most single area, routine exams cost $900.
The price of your scan will be dependent on the time needed for your scan, complexity and whether or not an injection of contrast is required.
The price of your scan will be confirmed once we have received your doctor's referral and supporting information.
Below is an example of our most common MRI scan fees $900 Brain $900 Spine (per segment: cervical, thoracic or lumbar) $900 Joints (per ankle,elbow,wrist,shoulder,knee,hip) $1400 Arthrograms (incl contrast) $1600 Abdomen (incl contrast) $1100 Breast (implant assessment) $1900 Breast (cancer staging)

64-slice CT
Diagnostic Scans
$600 Routine, non-Contrast $1100 With IV Contrast

Dental Scans
$300 Mandible OR Maxilla $450 Mandible AND Maxilla

Article: How to Read an Ultrasound Picture. INDEX
0-Ultrasound/arts/How to Read an Ultrasound Picture-5 Steps (WikiHow).html
Online: http://www.wikihow.com/Read-an-Ultrasound-Picture

Obstetric ultrasound has been a useful diagnostic tool since the 1950s and is considered to be a safe, non-invasive, accurate and cost effective way of monitoring the development of the growing baby. Real-time scanners are used today to show a continuous picture of the moving fetus on a monitor screen, to be interpreted by experts as they look for important medical information. ....

Understand the difference between the colors.
A sonogram or ultrasound picture is a black and white photograph, which can be a little confusing to interpret at first. Once you appreciate that black is liquid and white is solid, it is easier to see the details of your baby.
The more solid the tissue, the whiter it will appear on the ultrasound, for example, bones are light grey or white and the placental fluid will be black.

Determine the orientation of the picture.
In a longitudinal image, the mother's head would be on the left of the picture.
In transverse images, the mother's head would be at the top of the picture.
The next thing to look for is whether the fetus is head down, towards the cervix or whether it is in the breech position, with feet down.
Look for the spine to see if the fetus is facing left or right, as this makes it easier to determine the position of internal organs.

Look for identifying characteristics of your baby.

The baby's gender can be determined from the beginning of the second trimester.
Sometimes the baby does not cooperate and a leg gets in the way and you have to wait for the baby to move or for the transducer to be moved to a different angle.

The details of the baby's head and face can be seen at this stage quite clearly and you can distinguish cheeks, eyelids, nose, lips and chin, and sometimes hair is already visible on the baby's head.

A visible heartbeat can be seen as early as six weeks and this is an important indication of fetal health as the pregnancy develops. It is also an indication of the gestational age of the fetus, which helps the calculation of the due date.

Identify any structural abnormalities.
Your doctor or health care provider also takes fetal body measurements to monitor the size and growth of the baby, and the first sonogram gives parents an opportunity to identify any structural abnormalities.

Cleft lips and palates, congenital heart abnormalities, Down syndrome, spina bifida and other conditions can be identified at this stage.

Placental abnormalities, the amount of amniotic fluid and other conditions such as ovarian cyst can also be detected in ultrasonography.

Finished.

Tips

The newer technology of Doppler ultrasound is being commonly used to assess and monitor the fetus' growth and heart rate. More recently, 4D or dynamic 3D scanners have been introduced onto the market giving an even clearer image of the baby's facial features and movements before birth.
There is no hard and fast rule about the number of scans a woman should have.
The 18 to 20 week scan is becoming a matter of routine practice; doctors order further scans if anomalies are detected. Every now and then, articles appear in magazines suggesting harmful effects of diagnostic ultrasound but these have never been proved in larger studies. Whether all women should undergo ultrasound screening and whether such screening improves outcomes is still controversial. The American College of Obstetrics and Gynecology states that routine screening is not mandatory, but is reasonable in patients who request it.

Warnings

Studies have shown that ultrasounds are not always reassuring for an expectant mother and anxiety actually increases until the scan is interpreted and fears are allayed. Mothers' interpretations of their scans depended on their personal and social circumstances and feedback from the operator needs to be in language that is not unfamiliar or alarming to the mothers.
The biggest danger from ultrasound imaging is the over- or under- diagnosing brought about by inadequately trained staff, often working in isolation or using poor equipment. There is a wide difference in the skill, training, talent and interest of sonographers, so parents should be aware that reading a sonogram is not a 100% diagnosis. Reported figures range from 40 to 98 percent accuracy so a normal scan cannot be an absolute guarantee that the baby is normal, as some abnormalities are very difficult to detect. The position of the baby in the uterus has a great deal to do with how certain organs, such as the heart, may be seen.
Bear in mind that it may take several months or years training for an ultrasound technician to become expert and to understand the process well. Parents should be happy to have their image of a healthy growing baby, even if it is difficult to appreciate all the information in the scan and they should certainly rely on the experts when it comes to interpreting the scientific details.

-Basics-: How to read an ultrasound image. INDEX
0-Ultrasound/arts/Ultrasound Basics-How to read an ultrasound image(EI).html
Online: http://www.eimedical.com/blog/bid/76503/
Ultrasound-Basics-How-to-read-an-ultrasound-image
Posted by Mia Varra on Tue, Mar 27, 2012
Have you ever looked at an ultrasound image and wondered "What" are you looking at?
Ever wonder which end is up? When others are discussing Bull or Heifer, ovarian diagnosis, or metritis treatment are you still looking to decide "What" it is?? Well, if you feel left in the dark when it comes to ultrasound images .. let's start back at the basics.
Ultrasound is a non-invasive, immediate tool used to image tissue.
It will not penetrate bone (like an X-Ray).
So the first step to help you read the ultrasound image is to be familiar with the anatomy that you are imaging.

Various body tissues conduct sound differently.
Some tissues absorb sound waves while others reflect them.
The density of the tissue dictates the speed at which the echoes return.
If you remember that FLUID is always BLACK and TISSUE is GRAY.
The denser the tissue, is the brighter white it will appear in ultrasound the brightest white being bone.
Remember, the more images you see the easier and clearer they will become.
Of course, choosing the right ultrasound equipment from a creditable company should also be an important decision.

ADDITIONAL:
Other causes for increased .. echogenicity include
acute cortical necrosis, chronic glomerulonephritis, Alport syndrome, prolonged hypercalcemia or hypercalciuria, ethylene glycol poisoning, and sickle cell disease.
Acoustic shadowing can occur because of the intensity of the renal echoes or development of renal stones.

-Video-: Abdominal Ultrasound (Sonography), Mark Guenin, M.D., 4.28 min INDEX
0-Ultrasound/mp4/abdominal-ultrasound-explained.mp4
Online: http://www.radiologyinfo.org/en/info.cfm?pg=abdominus
Radiology.info.org

High frequency sound waves are used to create sonar-like images of solid and fluid-filled organs.

Reasons used:
Diagnostic

Why a patient has abdominal pain.
Abdominal liver blood tests.
Enlarged abdominal organ.
Stones in the gallbladder or kidney.
Aneurisym in the abdominal aorta.

Guidance for Biopsy procedures.

Refrain from eating for 8 to 12 hours before the procedure.
Drink 4 to 6 glasses of water an hour before a kidney exam.
Doppler ultrasound can measure and show blood flow.
Pictures are taken and then interpreted by a radiologist.

Benefits:

Generates clear pictures of soft tissues which do not show up well on X-rays.
Non-Invasive, no needles involved, painless.
Widely available, easy-to-use.
Relatively low cost compared to other diagnostics.
No radiation.
Time scan pictures can be provided.

Disadvantages:

Cannot penetrate or leap across gas pockets.
Cannot image hollow or empty digestive tract, stomach, small or large intestine, and other similar areas.
Can be difficult to do on oversized and fatty patients.

Article: Sonographic Mimics of Renal Calculi. INDEX
0-Ultrasound/pdf/Mimics--Renal Calculi.pdf --- 7 pg PDF
Durr-e-Sabih, MBBS, MSc, Ali Nawaz Khan, MBBS, FRCP, FRCR, Marveen Craig, RDMS, Joseph A. Worrall, MD, RDMS
2004 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 2004; 23:1361--1367 . 0278-4297/04/$3.50
Online: http://www.medicinenet.com/script/main/art.asp?articlekey=6141

Objectives.
To review sonographic findings that can mimic renal calculi. ..
Results.
There are a number of sonographic renal artifacts, vascular and nonvascular, that may confound a correct diagnosis.
Conclusions.
Awareness of these potential artifacts will result in a more specific sonographic examination and will accurately guide the referring physician toward appropriate patient treatment. The importance of other imaging modalities is also emphasized to ensure that a correct diagnosis is obtained whenever the sonographic findings are inconclusive.

Renal calculous disease is a frequent cause of lumbar pain, ...
Proper sonographic technique usually allows visualization of most calculi larger than 5 mm. When imaging smaller renal calculi; however, recognition and diagnostic accuracy are less clear, and such stones may be missed or misdiagnosed because of the presence of many inherently bright intrarenal noncalculous echoes. This review concentrates on those bright echoes that represent sonographic artifacts, normal or common (anatomic) renal structures that may mimic renal calculi.
Normal or calcified renal vessels are the most notable and common causes of intrarenal bright echo reflectors.
The kidneys are among the most vascular organs within the body; they can even be considered to form physiologic arteriovenous shunts. The renal volume of both kidneys is approximately 300 mL, and they are perfused by the equivalent of 25% of cardiac output, which can be up to 1.5 L. It is not surprising that, with so many vessels, some may present orthogonally to an ultrasound beam and may appear more echogenic than the background parenchyma, and some of these normal vessels, imaged at just the right angle, may appear as small, brightly reflective "specks."

Some of these renal vessels appear in predictable locations and in a recognizable pattern, thus allowing their identification as "nonstones." A brief review of renal vascular anatomy shows that each renal artery divides into 5 segmental arteries, with each segmental artery subsequently dividing into interlobar arteries. Segmental arteries often cross the papillae at right angles, with the division frequently occurring very near the medullary pyramids. The interlobar arteries travel along the sides of the renal pyramids and, at the level of the pyramidal base, give off parallel arcuate arteries.
... Renal Cortical Calcification
There are a variety of causes that produce renal cortical calcification, shown as increased cortical echogenicity and shadowing, and that may mimic calculi. Some of these causes include acute tubular necrosis, chronic glomerulonephritis, Alport syndrome, oxalosis, rejected renal transplants, and chronic neoplastic hypercalcemia.
... Current imaging algorithms in the developed world use CT as an initial imaging modality for diagnosis of possible renal calculi. However, these algorithms have changed fairly rapidly during the last few years. Examples of the changing recommendations include the following:

1. 1992, Plain abdominal radiography and sonography should replace intravenous urography;
2. 1993, Intravenous urography should be added to the protocol if radiography and diagnostic sonography are inconclusive; and
3. 1995, Unenhanced helical CT should replace urography.

There are limits to the size of stones that can be sonographically detected, depending on resolution and probe frequency, as well as the type of stone, its location, patient habits, and hydration. Whenever a nondiagnostic study is performed, a useful tactic is to repeat the sonographic examination after overhydrating the patient to produce mild splitting of the renal sinus and to make the diagnosis easier.
Expecting to be able to detect submillimeter calculi on sonography is fraught with danger, and many false-positive diagnoses may be made. Five millimeters appears to be the cutoff size at which we can confidently expect to see renal calculi. Under experimental conditions, some authors have reported sensitivity of 2 mm, but most consider 5 to 7 mm to be the smallest visible size on sonography.
For detection of smaller stones, diagnostic confidence levels vary with operator expertise, machine sophistication, stone location, and patient anatomy. The sensitivity of sonography for diagnosing small renal stones varies from 24% to 96%. Helical CT has consistently been shown to have superior sensitivity.

Muscular pain due to mechanical injury is a very common cause of flank pain and affects approximately 85% of Americans during their lifetime. Patients with acute lumbar pain might have a renal stone, but renal stone disease is not invariably present. In one series, only 67% of patients had a renal stone related cause of acute lumbar pain, and, of these, only 66% had a correct diagnosis by sonography. Helical CT has nearly perfect sensitivity for detecting small stones and is excellent for diagnosing nonstone causes of flank pain. However, helical CT is not universally available, has a considerable radiation burden, and uses iodinated contrast agents. A combination of history, sonography, and plain and contrast-enhanced radiology might have to suffice in this imperfect situation.
The diagnostic approach to renal colic has recently been changed because of the introduction of new noninvasive radiologic procedures such as Doppler sonography, non-contrast-enhanced CT and magnetic resonance imaging. However, sonography remains the initial imaging procedure of choice in many cases because it is widely available, inexpensive, and noninvasive and does not rely on ionizing radiation or contrast agents.

Video: Transcription CAUTION. INDEX

These guidelines/cautions apply to the use of Linux MINT-14 operating system and the following programs to effect a view-and-transcribe recording of information. Use of other operating systems and other versions of these programs may induce similar or different, or no problems.

Caja 1.4.0 File Manager
EditPlus 2.10c
VLC Media Player, 2.0.5 Twoflower

What was experienced on enough occasions was a complete loss of or degradation of, or contamination of .. the instructions processing EACH program ... some form of cross-contamination.
These instances occurred at erratic times and presented significant though NOT consistent failure symptoms.
Frequently, it was necessary to PAUSE the VLC Media Player during the playback of a SLIDE video to provide time for the typing of the details on the display into the EditPlus document. The software BREAKS always occurred during one of these pauses.
Simultaneously, visual reference to both the VLC display and the EditPlus input procedure began to fail ... by stalling, partial display loss, lack of keyboard response, loss of command access. The computer would have to be restarted and the integrity of the EditPlus file would have to be checked and remedied as best as possible.
The VIDEO portion appeared to FAIL first and independent of the AUDIO, almost always during a PAUSE.

NOTE: In order to manage storage space better for backups and transfers,
FLV and PDF files have been moved to another folder and their-in-document LINKS have been concealed.

SUGGESTIONS:

SAVE your edited file OFTEN .. every several lines.
Concurrent operation of any other software is best done with the expectation that a SUDDEN collapse of the operations is likely to occur.
When an EditPlus file is terminated without saving the last entries, consider whether to reactivate the .bak file.
When a BACKUP operation is suddenly terminated, confirm what the Last COMPLETE saved file and folder were. Determine whether to delete the last partial file or folder and restart the BACKUP process from the last SAVE operation that has complete Integrity/Accuracy/Completeness.
At the FIRST suggestion of an apparent inconsistent rendering of the video, SAVE the file being edited, QUIT the video, and, RESTART the computer to clear the operational dysfunction (sometimes signified by a loss and corruption of display images for any and all open software ... EditPlus, File Manager, etc.
Video contents can be transcribed to paper and then entered into an EditPlus document; however, this is a very time and energy consuming and paper intense process.

Video: Abdominal, Landmarks , 18.41 min INDEX
0-Ultrasound/flv/Ab-ultra--landmarks.flv
Online: https://www.youtube.com/watch?v=YnaNdya3jOc
Florida National University.
(Heavy French accent English and distant weak sounding assistant.)
Finding abdominal "landmarks".

Tip of the Liver.
Diaphragm, from right Kidney.
Aorta artery & Inferior Vena Cava (IVC).
IVC Transverse.
Confluence
Anacoid branch.
Superior Mesenteric Artery.

Portal ... artery and Common Bile Duct.
Vertebral Column.
Small Intestine and Colon GAS, hides

Hepatic Artery.
Common Bile Duct.
Hepatic Artery.
Splenic Artery.
Gall Bladder, right side.
Main Lower ...
IVC,
Round Ligament
Left Lobe of the Liver.
Left Lobe in Transverse.
Right Lobe of the Liver.
Right Lobe in Transverse.
Liver and Cortex of the Kidney.
Caudet Lobe of the Liver.
Gall Bladder inside ...
Gall Bladder in Transverse.
Pancreas in Transverse.
Spleen intercostal, from left side.
Spleen transverse.
Right Kidney, from right side.
Morison post .. between Liver and Kidney.
Left Kidney in Transverse .. from behind left Side.
Right Kidney Cortex .. from front, right side.

Video: Part 01 - Abdominal Ultrasonography in Small Animals. 11.04 min INDEX
0-Ultrasound/flv/Ab-ultra--part_1.flv --- 10.4 MB
Online: https://www.youtube.com/watch?v=KUZ0ZB0YMtc
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)

1. First a good clinical examination & laboratory tests.
2. Evaluation of all abdominal organs
... Changes in size, shape, structure ... presence of nodules or masses.
3. No definitive diagnosis without fine needle aspirations (FNA) or biopsies.

Ultrasonography of the Liver.
Indications
--- Hepatomegaly (palpation or RX) --- Cranial abdominal mass. --- Jaundice. --- Increased liver enzymes. --- Metastasis check (staging) --- Fever of unknown origin. --- Gastro-intestinal signs. --- PUPD --- Aspiration/biopsy.

Transducer caudal to the xyphoid process of the sternum.
Probe directed cranially and dorsally.
(To view as much of the liver as possible)
Intercostal (probe between the ribs) approach if necessary.
Caudal to the diaphragm.
Cranial to the stomach, spleen and right kidney.
Liver parenchyma.
--- Sharp and pointy (triangular) edges of lobes. --- Homogeneous parenchyma. --- Echogenicity: kidney, liver, spleen.

Liver parenchyma: diffuse changes.

--- Increased echogenicity (hypergenicity) .. brighter than or similar to the spleen.
- Lipidosis (increased attenuation of the beam strength) - Fibrosis - Lymphoma - Steroid induced hepatopathy.

-- Decreased echogenicity (hypogenicity) .. darker than renal cortex.
-- Increased visibility of the walls of the portal vessels.
- Acute hepatitis - Congestion - Lymphoma - Leukemia.

-- Diffuse heterogeneity.

- Chronic hepatitis - Hepato-cutaneous syndrome - Neoplasia.

Liver parenchyma: focal changes.

--- Anechogenic.
- Cyst - Metastasis - Necrosis - Hematoma - Abscess.

--- Hypoechogenic. .. difficult to discern between Benign and Malignant.
- Neoplasia: Metastasis or Lymphoma - Nodular hyperplasia - Necrosis - Abscesses.

--- Hyperechogenic.
- Benign lesions - Fat - Mineralization - Steroid hepatopathy - Neoplasia/metastases.

--- Mixed echogenicity.
- Neoplasia/metastases - Abscesses - Hematoma - Nodular hyperplasia.

Always perform FNA or biopsy for confirmation/clarification.
Check coagulation and platelets count.

Video: Part 02 - Abdominal, Biliary Tract, Small Animals. 4:58 min INDEX
0-Ultrasound/flv/Ab-ultra--part_2.flv
Online: https://www.youtube.com/watch?v=Ut7sgJa4uds
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)

Gallbladder
Common Bile Duct
Bile = anechoic (Normal)
Presence of sludge or mud usually normal (dogs)
--- less normal in Cats.

Diseases:

Sediment/calculi
Obstruction (usually ectrahepatic)
- Pancreatitis
- Calculi, Plugs
- Neoplasia

Cholestasis

Mucocoele
- Excessive accumulation of mucus in lumen
- Stellate (spots) or kiwifruit pattern

Thickening of the gallbladder wall.
- Oedema of the wall (right side heart failure, hepatitis, hyperalbuminemia)
- Neoplasia (biliary carcinoma)
- Trauma (rupture)

Cholecystitis

Video: Part 03 - Abdominal, Pancreas, Small Animals. 10:48 min INDEX
0-Ultrasound/flv/Ab-ultra--part_3.flv --
Online: https://www.youtube.com/watch?v=rtEgS85t_2k
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
(This video is poor quality and may crash the VLC viewer !)
Indications.

Severe abdominal pain.
Acute vomiting +/- diarrhea.
Anorexia (esp in cats).
Hypoglycemia (insulinoma)
Jaundice (extrahepatic biliary obstruction secondary to disease).
Focal peritonitis or mass effect in the region of the pancreas on abdominal radiographs.

The pancreas is often difficult to see.
The left lobe (larger in cats)
- between the stomach and the transverse colon.
- between the stomach, spleen and left kidney.
-- more difficult to see in dogs.
The right lobe (larger in dogs)
- dorsomedial to descending duodenum.

Pathologies.
Acute pancreatitis

Enlarged pancreas.
Hypoechoic pancreas.
Widened pancreatic duct (in cats).
More subtle signs in cats .. may be difficult to detect.
Hyperechoic fat.
Localized free fluid.
Localized functional ileus.
-- (lumen is Open, normally collapsed when not in digestion mode)
--- usually filled with fluid but can also be filled with gas.
Secondary dilation of the common bile duct.
- Obstruction of the common bile duct may lead to this.

Pancreatic oedema

Hypoalbumunemia.
Portal hypertension.
Some cases of pancreatitis.

Other Pancreatic Disorders
- gastrointestinal gas may obscure much visualization

Neoplasia.
- Adenocarcinoma insulinoma
--- small nodes may become aggressive and grow quickly.
- Metastasis of liver, lymph nodes, mesentery.
Cysts.
- Retention cysts, pseudocysts, congenital cysts.
- Often present no symptomatic problem to the animal.
Nodular hyperplasia.
Abscess.
- Can be quite severe and be difficult to treat.
- When present, there is often surrounding inflammation.

Follow up with biopsies or aspirations of any lesions.

Video: Part 04 - Abdominal, The Spleen, Small Animals. 13:08 min INDEX
0-Ultrasound/flv/Ab-ultra--part_4.flv
Online: https://www.youtube.com/watch?v=lHsJJYaiK5w
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
- the video tends to be poor quality.
Indications.

Generalized splenomegaly.
Abdominal mass. (by palpation or X-ray)
Hemoperitoneum.
Trauma.
Acute abdominal pain.

Guidelines.

Located in the left cranial abdomen.
-- attached to the stomach by a ligament.
The exact position is variable.
- along the left abdominal wall. (dogs and cats)
- crossing to the right side (dogs)
Homogeneous echotexture.
Smooth hyperechoic capsule.
Splenic artery (difficult to see).
Splenic vein (visible at the hilus).
- drains into the portal vein.
Begin with the probe on the left side below the stomach.
- May be necessary to look between the ribs.
The spleen will always be brighter than the liver and the kidneys.

Pathologies.
Diffuse splenomegaly
Passive congestion.
Anesthesia/sedation.
Infection.
Immune mediated diseases.
Neoplasia, Lymphomas.
Torsion.
Parasitic infections (babesia, Ehrlichia).

Diffuse splenic changes: tumors
Diffusely hyperechoic, hyperechoic, or mottled.
Lymphoma.
Malignant histiocytosis.
Mastocytoma.
Leukemia.

Diffuse splenic changes: Thrombosis/torsion
-- will also impose a blockage of the vessels
-- difficult to tell difference between thrombosis & torsion.
Severely increased size.
Diffusely hypoechoic.
Hyperechoic striations ("Dark sky with stars").
Hyperechoic (fat) triangle at the hilus (mostly w/torsion).
Absence of flow.

Splenic parenchyma: focal lesions
- Hypoechoic lesions (frequent in dogs)

Neoplasia.
- Lymphoma.
- Mast cell tumor.
- Malignant histocytosis.
- Hemogloscarcoma.

Metastasis.
Hematoma.
Infarction (acute).
Nodular hyperplasia.
Cysts.
Extramedullary.

- Hyperechoic lesions (more rare)

Neoplasia.
- Mast cell tumor.

Metastasis.
Infarction (chronic).
Nodular hyperplasia.
Myelolipomas.

- Mixed lesions

Hematoma.
Abscess.
Nodular hyperplasia.
Metastasis (target lesion).
Neoplasia (Hemangiosarcoma).

- Splenic Nodules

In cats:
- Always suspicious.
--- Fine needle aspiration.

In dogs: (more complicated)
-- Fine needle aspiration.
--- Regular rechecks, every 1 or 2 months.

Follow up with biopsies or aspirations of any lesions.

Video: Part 05 - Abdominal, Gastro-Intestinal Tract, Small Animals. 13:04 min INDEX
0-Ultrasound/flv/Ab-ultra--part_5.flv
Online: https://www.youtube.com/watch?v=vfYGP0Buj5g
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)

Indications.

Vomiting (chronic or acute).
Diarrhea (chronic or acute).
Weight Loss.
Anorexia.
Hypoproteinemia.
Blood loss (hematemesis, ulcer, melanoma, ..).
Abdominal pain.
Tenesmus.

Guidelines.

Animal has fasted for 12 hours, at least.
GI gas interferes with the examination of the GI tract.

Pathologies
Ultrasonography of the Stomach.
Location in the cranial abdomen (partially under the ribs).
Rugal folds of the stomach tissue with some gas present.
Prominent hyperechoic submucosa (fat) in cats.
Peristaltic movement (4-5 contractions/min).
Normal wall thickness of 3-5 mm.
-- Check for obstructions in the Duodenum or pressure being exerted against it or the upper intestines.

Duodenum
Proximal part may be difficult to access (deeply under the ribs).
Descending duodenum superficial along the right abdominal wall & ventral to the right kidney.
Duodenal papilla are sometimes visible.
3-6 mm thick (dogs); less in cats.

Jejunum, ileum
Dispersed in the abdomen (more on the right side).
3-5 mm thick (dogs).

Cecum
- Right cranial abdomen.
Colon:

Contains air and feces.
Ascending on the right.
Transverse caudal to stomach.
Descending on the left.
2-3 mm thick (dogs).

- Layers of the GI Tract

Mucosal surface (lumen) hyperechogenic. (line in the center)
Mucosa: hypoechogenic.
Submucosa: hyperechogenic.
Muscularis: hypoechogenic.
Serosa: hyperechogenic.

Gastrointestinal patterns
Food (in the stomach).
-- Variably sized particles in the gastric lumen.
-- May mimic foreign bodies.

Ingesta (in the small intestines).
-- Isoechoic to hyperechoic fluid.

Fluid.
-- Anechoic content.

Air.
-- Hyperechoic with shadowing (comet tails)

Evaluation of GI diseases.
-- Criteria.
Wall thickness.
Wall layering. (should be always visible)
Size of any lesion.
Transition zone.
Content.
Motility.
Draining lymph nodes.

Problems.
Foreign body.
Hyperechoic surface.
Strong acoustic shadow.
Plication (if linear).
Obstructive ileus.

If Perforation:
-- Local peritonitis.
-- Free peritoneal gas.
-- Thickening of the wall.
-- Loss of layering.

For heavier, thicker bodies, a LOWER frequency may be required for DEEPER penetration,
though some resolution may be lost.
Follow up with biopsies or aspirations of any lesions.

Video: Part 06 - Abdominal, Adrenal Glands, Small Animals. 7:46 min INDEX
0-Ultrasound/flv/Ab-ultra--part_6.flv
Online: https://www.youtube.com/watch?v=hQlQHx2J54E
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
Normal Adrenal Glands.
-- Cranio-medial to the kidneys.
-- Left Adrenal:
ventral to the aorta, cranial to the left renal artery, caudal to the cranial mesenteric artery.
-- Right Adrenal: dorso-lateral to the caudal Vena Cava (CVC).
-- Mineralizations: normal in old cats, not in dogs.

Adrenal Mass. (Increased size of)
Adrenal tumors.
Adrenocarcinoma.
Adenoma.
Metastasis.
Phoechromocytoma.
Adrenal-dependent hyperadrenocorticism. (Cushing Syndrome?)
Enlargement on one side or the other.
+/- functional decreased size of the contralateral gland.
-- Adenocarcinoma or adenomoma.

Invasion of the surrounding tissues. (When a mass is found)
(caudal Vena Cava, renal (kidney) vessels ...)
Ultrasonography.
sometimes difficult to assess.
Invasion, or, compression ?
CT recommended to evaluate invasion of the tumor before surgery

If the mass is invading any vessel, it will be more difficult to remove, and,
it may result in a rupture of the vessel and subsequent secondary hemorrhage into the peritoneal space.

Pituitary-dependent hyperadrenocorticism.

Bilateral adrenal hypertrophy (hyperplasia).
Sometimes appear normal size in ultrasonography.
Plump shape indicates affected.
CT/MRI of the pituitary gland .. Adenoma.
-- bilateral adrenal hypertrophy.

Video: Part 07 - Abdominal, Kidneys. 11:33 min. INDEX
0-Ultrasound/flv/Ab-ultra--part_7.flv
Online: https://www.youtube.com/watch?v=10l0uN5g14s
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
Indications.

PU/PD.
Hematuria, anuria, pollacuria ...
Incontinence.
Abdominal mass.
Ascites (protein losing nephropathy).
Fever of unknown origin (pyelonephritis).
Abnormal laboratory tests (urea, creatine, urine analysis ..).
Abnormal kidney size on radiography.
Polycystic Kidney Disease (PKD) screening (in some breeds of cats).

Guidelines.

Left Kidney.
-- behind the last rib, close to the spleen.
Right Kidney.
- Just caudal to the caudate lobe of the liver.
- Under or just caudal to the last ribs.

Normal anatomy of the kidney.

Cortex: echogenic.
Medulla: hypoechogenic, divided by diverticula and interlobar arteries.
Renal pelvis, contains a small amount of fat.

Medullary rim sign.

Often not pathological.
Hypercalcemic nephropathy.
Ethylene glycol intoxication.
Acute tubular necrosis.
Chronic interstitial nephritis.
Feline infectious peritonitis (FIP)

Normal appearance of the kidney.
Echogenicity of the kidney ..
< or = liver

< spleen
Differences can be very subjective and difficult to assess.
Also depends upon the settings of the machine.

Normal Size of the kidney.
Cat = length = 3.0 to 4.3 cm
Dog: much more variable according to weight of animal.
Ratio K/Ao (Kidney length/Aorta diameter)
-- 3.3 to 9.1 cm

Abnormal Renal Shape.

Neoplasia.
Renal dysplasia.
PKD.
Lymphoma.
FIP.
End stage chronic renal disease.

Decreased Renal Size.
(not as common)
End stage chronic renal disease.
Renal dysplasia or hypoplasia. (congenital)
Amyloidosis.

Increased Renal Size.
(much more common)
One kidney may decrease in size and be compensated by the other increasing.
Kidney may appear large due to fluid between the kidney and the capsule.
Compensatory hypertrophy.
Nephritis.
Hydronephosis.
FIP.
Lymphoma.
Perinephric pseudocyst.
Perinephric hematoma.
PKD.
Neoplasia.
Amyloidosis (mild )
Portosystemic shunt (mild )
Acute renal failure (mild )

Diffuse abnormalities of the renal parenchyma.
Increased cortical echogenicity.
-- increased contrast between the cortex and the medulla.
Increased cortical and medullary echogenicity.
-- decreased CM definition.
Decreased cortical echogenicity.
-- decreased CM definition, cortex becomes darker.

Diagnostic Assessment.
Increased echogenicity of the renal cortex in the dog.

Glomerulonephritis.
interstitial nephritis.
Acute tubular necrosis.
Ethylene glycol poisoning
--- calcium oxalate deposition.
Other toxic agents (causing acute renal failure)
End stage renal disease.
Nephrocalcinosis (parenchymal calcifications)
Hypercalcemic nephropathy (medullary rim sign).
Leptospirosis.

does NOT provide much help in determining one or a few SPECIFIC possibilities.

Video: Part 08 - Abdominal, Bladder. 10:14 min INDEX
0-Ultrasound/flv/Ab-ultra--part_8.flv
Online: https://www.youtube.com/watch?v=l2wuWTDawXA
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(There is NO AUDIO to this presentation)
Indications.

Dysuria/pollakiuria/stranguria.
Hematuria.
Tenesmus / pain.
Incontinence.

Guidelines.

The bladder should be filled.

Wall.
- Hypoechoic layer surrounded by two hyperechoic lines.
- Normal thickness (full bladder): 1 to 2 mm .

Sometimes the insertion of the ureters is visible.

Ultrasonography of the bladder.
Numerous artifacts.
Reverberations.
Range ambiguity.
Side and grating lobes.
Refraction (when ascites).

Diffuse splenic changes: tumors
Diffusely hyperechoic, hyperechoic, or mottled.
Lymphoma.
Malignant histiocytosis.
Mastocytoma.
Leukemia.

To decrease them

Harmonic imaging.
Only one focal point.

Cystitis.

Chronic cystitis.
-- Wall thickened (cranioventrally or diffuse).

Polypoid cystitis.
--- small pedunculated masses.

Emphysematous cystitis.
--- Gas in bladder wall, lumen, or ligaments.
-- (hyperechoic line + dirty shadowing)
Due to gas-producing or glucose-fermenting bacteria.
--- Ecoli (Diabetes mellitus)
--- Clostridium
--- Proteus mirobilia

Ultrasonographic abnormalities of the bladder.

Sediment.
Uroliths.
Ureterocele.
Intramural ectopic ureter.
Diverticulum.

Blood clots in the bladder.

Secondary to trauma, bleeding disorders, infection, or, neoplasia.
Iso- or hyperechoic.
Irregular shape.
No Shadowing.
Sometimes adherent to the wall.
(Differentiate from mural mass neoplasia)

Neoplasia of the bladder.

Mural mass.
Heterogeneous.
broad based.
Well defined irregular borders.
Predisposed location of transitional cell carcinoma.
--- Trigone most commonly reported.
Possible secondary obstruction of the ureters.
---

"to be continued"

Video: Part 10 - Abdominal, Male Reproductive Tract. 14:47 min INDEX
0-Ultrasound/flv/Ab-ultra--part_10.flv
Online: https://www.youtube.com/watch?v=uLQ34dyKgQY
ECHOMEDIC.TV, Summer Session, Ghent University
Virginie Barbaret, DMV, Dipl ECVDI -- Veterinary Faculty.
(Spoken SLIDE presentation)
Ultrasonography of the prostate.
Indications.

Bloody discharge from penis.
Hematuria / dysuria.
Tenesmus / dyschezia.
Caudal abdominal pain.
Fever.
Infertility.

Guidelines.

Abdominal approach (but sometimes intrapelvic location).
Caudal to the bladder neck. (follow the bladder neck)

Homogeneous, hyperechoic, bi-lobed structure.
Urethra visible in the center (mildly hypoechoic).
Variation with age (bigger with older) or castration (small & hypoechoic).

Benign prostatic hyperplasia
Middle aged dogs.
Glandular hyperplasia (due to hormonal imbalance).
Often incidental findings.
May lead to clinical signs.
--- Dysuria, Tenesmus, bloody urethral discharge.
--- Rarely systemic signs.
Appears as ..

Symmetrically enlarged prostate.
Smooth borders.
Iso- to Hyperechoic parenchyma.
+/- multiple small hypo- to anechoic cysts
No sub-lumbar lymph node enlargement.
--- check to eliminate possible confusion with prostate.

Prostatitis.

Bacterial infection.
-- Usually ascending urinary infection.
-- Rarely from scepticemia.

Rarely fungal infection or lymphocytic or lymphoplasmocytic inflammation.

Often secondary to a primary disorder of the prostate.
--- Benign hyperplasia.
--- Squamous metaplasia.
--- Neoplasia.
Appears as ...

Symmetrical or asymmetrical enlargement
--- (may be heterogeneous but not always enlarged).
Heterogeneous parenchyma.
--- (multifocal hypoechoic or hyperechoic areas)
Cysts or cyst-like structures of variable size.
Possible abscesses or mineralizations (if chronic).
Capsule of the gland is usually intact, but could be interrupted.
Focal peritonitis
--- (hyperechoic fat, small amount of free fluid).
Mild to moderate reactive lymphodenapathy.
Fine needle aspirate for cytology and culture.

Prostatic Cysts.

In hyperplasia, prostatitis and neoplasia.
Developmental or congenital.
Often an incidental finding.
Aspirate, if larger, to look for infection.

Paraprostatic Cyst.

Fluid-filled embryologic remnants of mullerian ducts.
May communicate with intraprostatic cavitations.
Can become very large and extend into the pelvic canal.
"Double bladder sign" on abdominal radiography.
--- +/- mineralizations (cyst wall, stalk (part of cyst attaching to the prostate))
Appears as ...

Anechoic fluid-filled structure.
Variable wall: thin, thick, smooth, irregular.
+/- internal septae.
+/- focal echogenicities and membranes ..
--- (with possible sedimentation)
---- Can grow cranially into the abdomen, or caudally towards the perineum.

Prostatic neoplasia.

Seen in older neutered and intact dogs.
Metastases sublumbar lymph nodes.
--- also to the bones (lumbar spine) or lungs .. RX

May extend locally to urethra or bladder neck.
Variable histological types reported.
--- Adenocarcinoma, undifferentiated carcinoma
--- transitional cell carcinoma, squamous cell carcinoma,
--- hemangiocarcinoma, leucomyocarcinoma, lymphoma.
Appears as ...

Enlarged, irregular and asymmetrical prostate.
Hypoechoic heterogeneous aspect (+/- irregular cavitations)
Often hyperechoic foci within the parenchyma
--- +/- acoustic shadowing (mineralizations)
Possible disruption of the capsule.

Sometimes difficult to differentiate from prostatitis.
Assess the sub-lumbar lymph nodes for average size ..
--- IF severely enlarged and heterogeneous metastases ...
Look for signs of extensions (bladder, urethra) .. which indicate neoplasia.
Confirm, as relevant, with Fine Needle Aspiration / biopsy.

Video: Pitfalls in Abdominal Ultrasound Diagnostics. INDEX, 30:29 min
0-Ultrasound/flv/Pitfalls_in_abdominal_ultrasound_1.flv
Online: https://www.youtube.com/watch?v=SEIsSGmjYYk
Dr. B.S. Rama Murthy MD DMRD DNB
Srinivasa Ultrasound Scanning Centre,
Bangalore, India.
A PITFALL is a diagnostic dilemma or ambiguity which has a potential for wrong diagnosis.
This could broadly translate into either a limitation or controversy.
Pitfalls are classified here as "Look alikes" (one object is mistaken for another), and, "Artifacts".
Artifacts may occur as an extension of the nature of Ultrasound, or, as an indicator of What the Settings are of the diagnostic device.
In Ultrasound, an ARTIFACT is used for an image phenomenon that represents the real anatomical structure incorrectly. That is, something which is imaged as something which we feel it is not. An artifact could be false, multiple, or, misleading information introduced by the imaging system or by interaction of the Ultrasound with the tissues. In a medical diagnosis, an artifact could be of advantage
1. Ligamentum teres vs Spurious hepatic SOL.
--- Compare a transverse section with a longitudinal view to discern the true shape. --- An apparent DOT may be alternatively represented as an elongated structure. 2. Gallstone, vs GB lumen gas, vs GB mural gas, vs Pyloric gas. --- A gallstone can show a postural change. --- A gas may show a shadow, and, may also be present in other nearby structures. --- A gas may be next to the lumen, or, may present as "intramural" in the wall. --- Pyloroduodenal gas 3. GB (Gall Bladder) Sludge vs GB Polyp. --- Tumefactive sludge .. is the image crisp and sharp? --- Is the form in question, Separate, or, Attached to the wall of the gallbladder? --- A sludge can also (postural) shift with the patient orientation. --- A sludge cannot "Hang" from an ABOVE position; A polyp can. --- A re-examination in a week or 10 days will assist in clarification .. a Sludge will have changed in position; a Polyp will have remained in the same position. --- By viewing with Doppler, sludge will NOT light up/color, whereas a polyp will. 4. WES (Wall - hyperEcoic lumen - Shadow) sign vs Porcelain Gall Bladder. --- The wall of the organ can shadow greatly when it is calcified. --- The wall will be a SINGLE line, not 3-line appearance, when Calcified. 5. Gall bladder stone (Present, or, Absent) --- Beware of a Neck lurking stone. --- With the gall bladder, what appears to be the NECK, may not be. --- A stone will be surrounded by bile, -- Value of prone position examination .. always exposes the neck stones. 6. Gall bladder Mimics. --- GB dilated with sludge. ----- GB stasis and sludge level in CBD stone. --- Choledochal cyst can be confirmed by looking for a real GB (repositioning) --- Post op Cholecytectomy, MBD dilation (may appear to be a GB with several stones) (MBD = Main Bile Duct) may have several stones; GB may have been laproscopically REMOVED. Laproscopic incisions may heal within several months and not be obvious .. maintain History. --- Pyloroduodenal fluid can mimic the Gall Bladder. --- Non visualized Gall Bladder. A GB filled with sludge can appear to merge with the Liver parenchyma. Biliary atresia GB Carcinoma may replace the image of the GB with a solid mass with a stone or 2 inside. Contracted GB in Hepatic dysfunction -- look for the Main Hepatic fissure, which ... will connect the Undivided Right Portal Vein and the Gall Bladder neck --- Intrahepatic biliary ductal dilation VS Hepatic artery waxing. GBD (Gall Bladder Duct) stricture with IHBDD Hepatic arterial branches may appear prominent. (Doppler will confirm arteries) The Hepatic artery may become enlarged to facilitate blood flow to the Liver, when the Portal Vein is not large enough, especially in chronic liver disease, and, the dilated Hepatic artery may look like a dilated Bile Duct. ... Doppler will define the artery (color) as NOT a duct (no color) 7. Collapsed stomach VS Splenic Vein. (22:50 min) --- Pancreas is hidden behind the stomach and the collapsed stomach assumes the shape. 8. Posterior gastric wall VS Pancreatic duct. --- Curvature of the wall goes UP, whereas the duct would curve DOWN. 9. Hypertrophic Column of Bertin VS True space occupying lesion. --- Kidney confusion re. Bump on the renal contour -- Is it a solid mass? --- Optimize (Focus/increase) the image (brightens the image resolution) --- This may reveal the Cortex & Medulla of the Kidney rather than a "tumor". 10. Columnar hypertrophy of the kidney normally indents the sinus. 11. APCKD vs Hydroephrosis. --- Cysts are non-communicating, always bilateral, all random in size. --- Example of a Medial large cyst with peripheral smaller communicating cysts. 12. Renal Stone VS Milk of Calcium VS Papillary tip. --- A stone is only a stone if you can demonstrate a SHADOW. --- Raise the FOCUS setting on the display to the level of the "stone". --- "Milk of Calcium" display will show a straight Line border. --- A "Papillary Tip" will display as a "cup" with urine all around a stone. ------ The stone will fall down as the patient is moved.

NOTE: When searching for a particular organ,
begin by looking for the part of the organ which is always FIXED.

Video: Abdominal, Cardiac, Apical View. 4:57 min INDEX
0-Ultrasound/flv/Cardiac--Apical--SonoSite.flv
Online: https://www.youtube.com/watch?v=uiTsFtanyzM
SoundBites Cases, SonoSite Inc.,
Phillips Perera, MD RDMS FACEP
Emergency Ultrasound Director,
New York Presbyterian Hospital / Columbia University Medical Center.

Cardiac Echocardiography.
The Four Standard Views.

Probe Position A, Parasternal View - Long Axis.
Probe Position A, Parasternal View - Short Axis.
Probe Position B, Subxiphoid View.
Probe Position C, Apical View.

Probe Position C, Apical View.
Shows all 4 chambers in relation to one another.
Preparation.
Probe placed under the Left Nipple.
Point Maximal Impulse of Heart.
Have the Probe Indicator pointing to the Right BODY side.
The Ultrasound screen/display Indicator to the Left.
Left Decubitus position of the patient improves the image quality. (moves the heart closer to the probe and moves the lung out of the way.)

Interpreting the Images displayed.
A diagram is shown to the left of the ultrasound view.
Ventricles are at the top of the image, and closer.
Atria are at the bottom of the image, and, farther away.
The Tricuspid Valve is to the Left, between the Right Ventricle and Right Atrium.
The - Mitral - Valve is to the Right, between the Left Ventricle and Left Atrium.
The pericardium is the white line surrounding the heart.

Viewing the Heart in Action.
Good Contractility.
--- the walls of the Left Ventricle almost touch with each beat
..... indicating Good Contractility.

Dilated Cardiomyopathy condition.
--- the walls of the Left Ventricle present minimal change between beats.
..... indicating Very Poor Contractility

Pericardial Effusion-Swinging Heart.
--- patient presented with Acute Shortness of Breath
..... a Very Large circumference effusion is seen (light) surrounding (top) the heart.
---- the heart appears to swing back-and-forth, side-to-side, VS rising and lowering.

Cardiac Tamponade Apical View.
--- patient presented with Acute Shortness of Breath.
..... a Very Large circumference effusion is seen (light) surrounding (bottom) the heart.
---- the Right Ventricle appears to collapse and present little movement.

Photo: Abdominal, Aorta, dopwave17. INDEX
0-Ultrasound/sd-pix/aort-us-dopwave17.jpg
Online: https://www.youtube.com/watch?v=uiTsFtanyzM
2015 Radiological Society of North America, Inc. (RSNA)

Photo: Abdominal, Liver, abd-us-liver. INDEX
0-Ultrasound/sd-pix/abd-us-liver.jpg
Online: https://www.youtube.com/watch?v=r_aGI4Z_39Q
2015 Radiological Society of North America, Inc. (RSNA)

Video: Liver Ultrasound Anatomy. 6:21 min INDEX
0-Ultrasound/flv/LIVER_ULTRASOUND_ANATOMY_4.wmv
Online: ??

Diagram: Abdominal Veins.
--- The Superior Mesenteric Vein becomes the Portal Vein.
Picture: Hepatic vein color doppler ultrasound screen.
Diagram: Hepatic Portal System, extensive.
Picture: Abdominal veins and organs.

The LIVER takes blood in from the Hepatic Artery, and, the Portal Vein ...
the blood is cleaned and forwarded by the Inferior Vena Cava (IVC).
Picture: The Main Portal Vein (MPV) approaches the portal hepatis (a hilium of the liver) in a rightward, cephalic, and slightly posterior direction within the hepatoduodenal ligament.
The Gall Bladder comes in contact with the anterior surface of the Inferior Vena Cava (IVC) near the portal hepatis and serves to locate the liver hilium.

The Main Portal Vein (MPV) then divides into 2 branches ...
the Right (RPV) and Left Portal Veins (LPV). Each goes together with a branch of the hepatic artery and a branch of the bile duct to finish/exit in the IVC.
The Right Portal Vein (RPV) is larger than the left as the right lobe is the bigger one.
It is possible to identify the anterior and posterior divisions of the Right Portal Vein on sonography with the Right Hepatic Vein. The Left Portal Vein (LPV) lies more anterior and cranial than the Right Portal Vein (RPV).

The Hepatic Veins are divided into 3 components: right, middle, left ... entering the IVC.

The RIGHT hepatic vein is the largest and enters the right lateral aspect of the Inferior Vena Cava (IVC) (left side of the display).
The MIDDLE hepatic vein enters the anterior or right anterior surface of the Inferior Vena Cava.
The LEFT hepatic vein, which is the smallest, enters the left anterior surface of the Inferior Vena Cava (IVC).

Portal Veins have more echogenic (darker) borders than the Hepatic veins because they have a thicker collagenous sheath.
Hepatic veins do NOT have echogenic walls.
The hepatic arteries carry oxygenated blood from the aorta to the Liver.

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