Intro Sonographic Sectional Anatomy.pdf

Comparative Sectional Anatomy of the Abdominopelvic Cavity  Diagnostic Ultrasound Imaging  Documented ultrasound images include: The specific area or organ of the body being imaged Scanning plane Patient position  Visible anatomic landmarks and correct or...

Comparative Sectional Anatomy of the Abdominopelvic Cavity  Diagnostic Ultrasound Imaging  Documented ultrasound images include: The specific area or organ of the body being imaged Scanning plane Patient position  Visible anatomic landmarks and correct orientation/probe placement allows Reader to recognize location  Must know- Gross anatomy Sectional anatomy Anatomic variations Sonographic appearance2  Anatomic Position  Anatomic position assumes that the body is standing erect, the eyes/head are looking forward, and the arms are at the sides with the palms and toes directed (facing) forward. 3 Anatomic Position 4 Patient Positions 5  Body Cavities  Dorsal*  Ventral*  Thoracic  Abdominal  Pelvic 6  Body Cavities Two Main Body Cavities  Dorsal cavity- posterior (dorsal) side of the body; Contains the cranial cavity and spinal cavity  Ventral cavity- anterior (ventral) side of the body; The ventral cavity is divided into thoracic and peritoneal cavities by the diaphragm  Thoracic cavity—Division of the ventral cavity; An enclosed area that basically corresponds to the rib cage. Separated from the abdominal cavity by the diaphragm. Contains the bronchi and lungs 7  Body Cavities Peritoneal Cavity  Abdominal cavity— Division of the ventral cavity and peritoneal cavity that extends inferiorly from the diaphragm and is continuous with the pelvic cavity through the pelvic inlet  Pelvic cavity—Division of the ventral cavity and peritoneal cavity that extends superiorly from the iliac crests to the pelvic diaphragm inferiorly. Continuous with the abdominal cavity False pelvis—Superior to pelvic inlet. Also called greater pelvis or pelvis major. True pelvis— Inferior/deep to pelvic inlet. Also called lesser pelvis or pelvis minor. 8 Abdominal Quadrants 9  Abdominal Quadrants  The abdominopelvic cavity is divided into four quadrants 1. Right upper quadrant (RUQ) 2. Left upper quadrant (LUQ) 3. Right lower quadrant (RLQ) 4. Left lower quadrant (LLQ) The quadrant is determined by the midsagittal and transverse planes that pass through the umbilicus. 10 Abdominal Regions (Cont.) Surface landmarks of the anterior abdominal wall. 11  Abdominal Regions  The abdomen is commonly divided into nine regions by two vertical and two horizontal lines.  The surface landmarks of the anterior abdominal wall help define the specific abdominal regions. 12 Abdominal Regions 13  Abdominal Regions (Cont.)  Each vertical line passes through the mid-inguinal point This point lies on the inguinal ligament halfway between the pubic symphysis and the anterosuperior iliac spine  Subcostal plane: The upper horizontal line joins the lowest point of the costal margin on each side of the body  Intertubercular plane: The lowest horizontal line joins the tubercles on the iliac crests  Transpyloric plane: The horizontal plane passes through the pylorus, duodenal junction, neck of the pancreas, and hilum of the kidneys 14  Directional Terminology -used to describe relationship of two structures to one another 15 Anatomic Position 16  Directional Terminology  Anterior -nearer the front, especially situated in the front of the body  Posterior -further back in position; or nearer the back of the body  Superior -further above or toward the head; higher in position  Inferior -low or lower in position or toward the feet  Medial -situated near the median plane of the body or the midline of an organ 17  Directional Terminology  Lateral -side of the body or a body part that is farther from the middle or center of the body  Longitudinal - Pertains to the length or the view that shows its length  Superficial and Deep Superficial structures are those located close to the surface of the body Deep structures are those located farther inward, away from the body surface (skin line) 18  Planes or Body Sections (Cont.)  The sonographer images the body in multiple planes which include, but are not limited to: Transverse Sagittal Longitudinal* pertains to the longest length of an organ Coronal 19 Classic Body Planes 20 Transverse Plane 21  Planes or Body Sections  Transverse (Axial) Horizontal to the body Upper and lower portions  Sagittal Lengthwise plane running from front to back Right and left sides Midsagittal plane divides the body into equal halves  Coronal Lengthwise plane that runs from side to side Anterior and posterior portions  Longitudinal (scanning plane) Longest length of the organ in question can be sagittal or transverse 22 Transverse Plane (Cont.) Copyright © 2018 Elsevier Inc. All rights reserved. 23  Transverse Scanning Plane  Longitudinal section of the: Right renal artery (RRA) Right renal vein (RRV)  Axial section of the: Mid portion of right kidney Gallbladder (GB) Liver 24 Sagittal Plane Copyright © 2018 Elsevier Inc. All rights reserved. 25 Sagittal Plane 26 Sagittal Plane Right Lobe of the Liver Copyright © 2018 Elsevier Inc. All rights reserved. 27 Sagittal Plane Right Lobe of Liver/ Right Kidney Copyright © 2018 Elsevier Inc. All rights reserved. 28 CT Coronal Image (Cont.) Copyright © 2018 Elsevier Inc. All rights reserved. 29 Describing Sonographic Appearance  Terminology  Anechoic/Sonolucent- Echo-free (black)  Echogenic- Able to produce echoes (bright) Comparative Terms  Hypoechoic- describes an area that is NOT as bright as another  Hyperechoic- describes an area that is brighter than another Anechoic/Sonolucent 32 Echogenic or Hyperechoic 33 Hypo/Hyperechoic 34  Terminology cont.  Echo texture- describes the sonographic appearance of soft tissue structures within the body Homogeneous or heterogeneous  Organ Parenchyma Homogeneous or uniform echo texture Liver =homogeneous and moderately echogenic Kidneys are hypoechoic compared to the liver  Homogeneous  Homogeneous: completely uniform in texture or composition; opposite of heterogeneous  Example: The textures of the liver, thyroid, testes, and myometrium are generally considered homogeneous. 36 Homogeneous Copyright © 2018 Elsevier Inc. All rights reserved. 37  Heterogeneous  Heterogeneous: not uniform in texture or composition; opposite of homogeneous  Example: Many tumors have characteristics of both decreased and increased echogenicity. 38 Heterogeneous (Cont.) 39 Homogeneous Vs. Heterogenous 40  Enhancement  Enhancement, increased through- transmission: sound that travels through an anechoic (fluid-filled) substance and is not attenuated; brightness is increased directly beyond the posterior border of the anechoic structure as compared with the surrounding area—this is “enhancement” Copyright © 2018 Elsevier Inc. All rights reserved. 41 Enhancement Copyright © 2018 Elsevier Inc. All rights reserved. 42  Shadowing  Shadowing: The sound beam is attenuated by a solid or calcified object.  This reflection or absorption may be partial or complete; air bubbles in the duodenum may cause a “dirty shadow” to occur secondary to reflection; a stone would cause a sharp shadow posterior to its border. Copyright © 2018 Elsevier Inc. All rights reserved. 43 Shadowing 44  Fluid-fluid Level  Fluid-fluid level: interface between two fluids with different acoustic characteristics; this level will change with patient position  Example: dermoid tumor with fluid level Copyright © 2018 Elsevier Inc. All rights reserved. 45 Fluid-fluid Level 46  Irregular Borders  Irregular borders: Borders are not well defined, are ill defined, or are not present.  Examples: abscess, thrombus, and metastases Copyright © 2018 Elsevier Inc. All rights reserved. 47 Irregular Borders (Cont.) 48  Isoechoic  Isoechoic::very close to the normal parenchyma echogenicity pattern  Example: metastatic disease Copyright © 2018 Elsevier Inc. All rights reserved. 49  Isoechoic Copyright © 2018 Elsevier Inc. All rights reserved. 50 Let’s apply what we’ve learned Any Questions?