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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5780_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •Basic Physical and Technical Principles
- •Physics of Ultrasound
- •Ultrasound Techniques
- •Color Duplex Sonography (CDS)
- •Imaging Artifacts
- •The Ultrasound Examination
- •Abdominal Sonography
- •Ultrasound Imaging of Joints (Arthrosonography)
- •Documentation and Reporting
- •Requirements for Documentation
- •Guideline-Oriented Documentation
- •Sonographic Nomenclature
- •Function Studies
- •Basic Principles
- •Sonographic Measurements
- •Interventional Ultrasound
- •Fine-Needle Aspiration Biopsy (FNAB)
- •Therapeutic Aspiration and Drainage
- •Principal Signs and Symptoms
- •Upper Abdominal Pain
- •Lower Abdominal Pain
- •Diffuse Abdominal Pain
- •Diarrhea and Constipation
- •Unexplained Fever
- •Palpable Masses
- •Enlarged Lymph Nodes
- •Edema
- •Renal Insufficiency and Acute Renal Failure
- •Jaundice
- •Hepatosplenomegaly
- •Ascites
- •Joint Pain and Swelling
- •Arteries and Veins
- •Examination
- •Aorta and Arteries
- •Vena Cava and Peripheral Veins
- •Cervical Vessels
- •Examination
- •Abnormal Findings
- •Liver
- •Examination
- •Diffuse Changes
- •Circumscribed Changes
- •Changes in the Portal Venous System
- •Kidney and Adrenal Gland
- •Examination
- •Diffuse Renal Changes
- •Evaluation and Further Testing
- •Perirenal Masses and Adrenal Tumors
- •Pancreas
- •Examination
- •Diffuse Changes
- •Circumscribed Changes
- •Spleen
- •Examination
- •Sonographic Findings
- •Bile Ducts
- •Examination
- •Intrahepatic Ductal Changes
- •Extrahepatic Ductal Changes
- •Evaluation and Further Testing
- •Gallbladder
- •Examination
- •Changes in Size, Shape, and Location
- •Wall Changes
- •Intraluminal Changes
- •Evaluation and Further Testing
- •Gastrointestinal Tract
- •Examination
- •Stomach
- •Small Intestine
- •Large Intestine
- •Urogenital Tract
- •Examination
- •Renal Pelvis, Ureter, and Bladder
- •Male Genital Tract
- •Female Genital Tract
- •Thorax
- •Examination
- •Chest Wall
- •Pleura
- •Lung Parenchyma
- •Thyroid Gland
- •Examination
- •Diffuse Changes
- •Circumscribed Changes
- •Major Salivary Glands
- •Examination
- •Abnormal Findings
- •Postoperative Ultrasound
- •Normal Postoperative Changes
- •Postoperative Complications
- •Search for Occult Tumors
- •Principal Signs and Symptoms
- •Sonographic Criteria for Malignancy
- •Evaluation and Further Testing
- •Subject Index


Important Sonographic Dimensions*
Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
The values indicated are mean values drawn from the literature. It should be noted that organ
dimensions may vary substantially from one individual to the next. Generally the values are not
correlated with age, height, or constitution and therefore should be treated as guidelines. Vascular
dimensions refer to inside diameters.
n
Prostate and bladder in transverse section
Prostate: Length I 35 mm, width I 45 mm
n
Prostate and bladder in longitudinal section
Bladder: Volume: length q width q height q 0.5
n
Thyroid gland in transverse section
Length 40–70 mm, width 10-30 mm
n
Thyroid gland in transverse section
Depth I 35 mm, volume I 25 ml
Male 350–750 ml; female 250–550 ml
Depth 10–20 mm, isthmus I 5mm
Volume: male I 25 ml, female I 20 ml
* From Schmidt G, Course Book in Ultrasound, 4th ed. Stuttgart : Thieme; 2004.

n
Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Aorta
Subdiaphragmatic I 25mm
n
Aorta
Above the bifurcation I 20 mm
n
Vena cava
Subdiaphragmatic I 20mm
n
Portal vein
Hepatoduodenal ligament I 13 mm
Intrahepatic I 11 mm

Contents
Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Gray Part: Basic Principles
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
1 Basic Physical and Technical Principles
2 The Ultrasound Examination
n
3 Documentation and Reporting
4 Function Studies
5 Interventional Ultrasound
n
49
n
53
Green Part: Ultrasound Investigation of
Specific Signs and Symptoms
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
6 Principal Signs and Symptoms
Blue Part: Ultrasonography of Specific Organs
and Organ Systems, Postoperative Ultrasound,
and the Search for Occult Tumors
yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy
312
n
400
293
n
322
334
n
n
188
n
214
n
262
n
352
n
375
412
n
425
n
431
n
437
7 Arteries and Veins
8 Cervical Vessels
9 Liver
n
231
10 Kidney and Adrenal Gland
11 Pancreas
12 Spleen
n
n
13 Bile Ducts
14 Gallbladder
15 Gastrointestinal Tract
16 Urogenital Tract
17 Thorax
n
18 Thyroid Gland
19 Major Salivary Glands
20 Postoperative Ultrasound
21 Search for Occult Tumors
n
1
16
n
46
n
62

Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
I

Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.

Thieme Clinical Companions
Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
ERRNPHGLFREORJVSRWFRP
Ultrasound
yyyyyyyyyyyyyyyyyyyyyyyyy yyyyyyyyyyyyyyyyyyyyyyyyyyy
Günter Schmidt, MD
Formerly Evangelisches Krankenhaus Kredenbach
Kreuztal, Germany
With contributions by
B. Beuscher-Willems, L. Brügmann, C. Görg, T. Grebe, L. Greiner
1091 illustrations
Georg Thieme Verlag
Stuttgart · New York
III

Library of Congress Cataloging-in-Publication Data is available from the publisher.
Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
This book is an authorized and revised translation of the 3rd German edition published and
copyrighted 2005 by Georg Thieme Verlag, Stuttgart, Germany. Title of the German edition:
Checkliste: Sonographie
1st German edition 1997
2nd German edition 1999
Translator: Terry Telger, Translations for the Health Sciences, Fort Worth, TX, USA
Important note : Medicine is an ever-chan ging science undergoing continual development.
Research and clinical experience are continually expanding our knowledge, in particular our
knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage
or application, readers may rest assured that the authors, editors, and publishers have made
every effort to ensure that such references are in accordance with the state of knowledge at
the time of production of the book.
Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the
part of the publishers in respect to any dosage instructions and forms of applications stated
in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist,
whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly
important with drugs that are either rarely used or have been newly released on the market.
Every dosage schedule or every form of application used is entirely at the user’s own risk
and responsibility. The authors and publishers request every user to report to the publishers
any discrepancies or inaccuracies noticed. If errors in this work are found after publication,
errata will be posted at www.thieme.com on the product description page.
Some of the product names, patents, and registered designs referred to in this book are in fact
registered trademarks or proprietary names even though specific reference to this fact is not
always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.
This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or
commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and
storage.
c 2007 Georg Thieme Verlag,
Rüdigerstrasse 14, 70469 Stuttgart, Germany
http://www.thieme.de
Thieme New York, 333 Seventh Avenue,
New York, NY 10001, USA
http://www.thieme.com
Cover design: Thieme Marketing
Typesetting by Hagedorn Kommunikation, Viernheim
Printed in Germany by Druckhaus Götz, Ludwigsburg
10-ISBN 3-13-142711-6 (GTV)
13-ISBN 978-3-13-142711-3 (GTV)
10-ISBN 1-58890-552-7 (TNY)
13-ISBN 978-1-58890-552-9 (TNY) 123456
IV

Preface
Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Preface
Rapid advances in ultrasound imaging have resulted not only from continual
improvements in equipment and new technologies, but also from expanded diagnostic capabilities. Color Doppler sonography and ultrasound contrast agents, combined
with advances in standardizing diagnostic criteria and defining guidelines, have led
to dramatic progress in sonographic diagnosis.
For example, it is now possible to use contrast-enhancing agents in nearly all areas of
ultrasonography, although the examiner’s experience and equipment availability
continue to limit these applications. For those who are still learning how to use
ultrasound, however, it is first necessary to acquire a sound basic knowledge of
this modality in order to take advantage of these new and expanded methods.
This book presents a comprehensive collection of B-mode scans, but also a quantitiy
of color Doppler images, as well as several examples of the uses of contrast-enhanced
sonography. For ease of use in different situations, it is divided into three parts
(gray: Basic Principles, green: Ultrasound Investigation of Principal Signs and Symptoms, blue: Ultrasound of Specific Organs and Organ Systems).
The editor and two other authors (Prof. Dr. Ch. Görg, Prof. Dr. L. Greiner) are regular
leaders of seminars run by the German Society for Ultrasound in Medicine (DEGUM)
and co-authors of three German editions of a similar text, and of other books on
sonography. Each of them has an area of interest and expertise in their daily experience and on courses on ultrasound from which the current imaging approaches have
been developed.
I extend special thanks to the staff at Thieme Medical Publishers, particularly Ms.
Stefanie Langner, Dr. Christiane Brill-Schmid, Ms. Anja Dessauvagie, Ms. Elisabeth
Kurz, and Mr. Stephan Konnry. They worked with the authors tirelessly and patiently
(and at times, with gentle insistence) to bring this book to completion. A number of
other men and women at Thieme Medical Publishers helped with the artwork, image
reproductions, and production of the book, and their help is gratefully acknowledged.
To all those who read this book, delve deeply into its contents, and use it as a practical reference, I wish much success in their dealings with ultrasonography.
Preface
PrefacePreface
Günter Schmidt
V

Contributors
Schmidt, Ultrasound © 2007 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Contributors
B. Beuscher-Wilhelms, MD
Medizinische Klinik
Contributors
ContributorsContributors
Krankenhaus Bethseda
Freudenberg
Germany
L. Brügmann, MD
Evangelisches Krankenhaus
Bernhard-Weiss-Klinik
Kreuztal-Kredenbach
Germany
C. Görg, MD
Professor
Medizinische Klinik
Klinikum der Universität
Department of Hematology/Oncology
Marburg
Germany
T. Grebe, MD
Evangelisches Krankenhaus
Bernhard-Weiss-Klinik
Kreuztal-Kredenbach
Germany
L. Greiner, MD
Professor
Klinikum Barmen
Medizinische Klinik A
Wuppertal
Germany
VI
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