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Atlas of Human Body Ultrasound Scanning_ Methods and Diagnostic Applications ( PDFDrive ).pdf
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M. Zhang

 

 

2.9\ Transverse Scanning of the Middle Segment of the Common Bile Duct at the Level of the Lower Part of the Pancreatic Head by Right Subcostal

Fig. 8.40  Transverse scanning the middle segment of the common biliary duct at the level of the lower part of the pancreatic head by right subcostal

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8  The Digestive System Organ Scanning

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2.9.1\ Scanning Method

The patient should be on fast for 8–12 h. Right subcostal scanning should be performed. Transverse scanning should be performed with the patient in a supine position. Probe should be put transversely in the high right lower left. Patients can be in full inspiration to make the left liver lobe go down as an acoustic window.

2.9.2\ Section Structure

Major areas: transverse view of the pancreatic head and the middle segment of the common bile duct. Ancillary areas—transverse section of the abdominal aorta and superior mesenteric artery, superior mesenteric vein, inferior vena cava, and gastric antrum. At this level, the common biliary duct runs down from the posterior pancreatic head to the groove which is between the pancreatic head and duodenum, and then the common bile duct has a inclination and runs into posterior medial wall of the descending duodenum. The common bile duct is located at the anterior-infe- rior vena cava.

2.9.3\ Measuring Method and Normal

The inner diameter of the common bile duct is measured when it is dilated. Measuring the inner diameter of the common bile duct is more accurate in this segment than in the upper segment. Normal value is about 0.3–0.6 cm. Diameter larger than 0.6 cm is abnormal.

2.9.4\ Clinical Application Value

Showing lesion in or around the common bile duct by transverse section may be more clear than by longitudinal section of it. This section is used to show the relationship between the common bile duct and the pancreatic head, the common bile duct and the lesion, as well as the lesion and the pancreatic head to judge the level of the common bile duct obstruction. Dilation of the upper segment common bile duct of the pancreas indicates that common bile duct obstruction is at the level of the pancreas. Dilation of the common biliary duct superior and posterior to the pancreas segment indicates that common biliary duct obstruction is at the level of the end segment or the duodenal ampulla.