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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 6 Liver Scanning Protocol 109
5. Move the transducer back onto the right lateral inferior lobe. Place
the transducer at the most lateral edge of the right costal margin
and use a very sharp subcostal angle to view the right lateral superior lobe. Move or angle the transducer right lateral and sweep
through and beyond the right lateral superior lobe. Note the dome
of the right lobe and adjacent pleural space.
LT
RT
NOTE: Even with sharp subcostal transducer angles the axial views of
the right lateral superior lobe in a transverse plane can be difficult to
visualize. As an alternative, try transverse plane intercostal scanning or
scanning in the transverse plane from the patient’s right side.
Alternative 1: Right Lateral Superior Lobe of Liver •
Transverse Plane • Anterior Intercostal Approach
Follow the same recommended scanning method as the one for
the sagittal plane, longitudinal survey, intercostal approach of
the right lateral superior lobe.
Alternative 2: Right Lateral Superior Lobe of Liver •
Transverse Plane • Right Lateral Subcostal Approach
Follow the same recommended scanning method as the one for
the coronal plane, longitudinal survey, subcostal approach of the
right lateral superior lobe.
Alternative 3: Right Lateral Superior Lobe of Liver •
Transverse Plane • Right Lateral Intercostal Approach
Follow the same recommended scanning method as the one for
the coronal plane, longitudinal survey, intercostal approach of
the right lateral superior lobe.
110 PART III Abdominal Scanning Protocols
Pancreas body
Posterior
Anterior
Posterior
Hepatic
Liver Required Images
Liver • Longitudinal Images
Sagittal Plane • Transabdominal Anterior Approach
NOTE: The required images are a small representation of what a sonographer visualizes during a study. Therefore, the images should provide
the interpreting physician with the most telling and technically accurate
information available.
NOTE: Measurements of the liver are not required unless indicated by
pathology.
1. Longitudinal image of the LEFT LOBE to include its inferior margin and the abdominal aorta.
Left lobe
Superior
Diaphragm
Bowel
Spine
Splenic artery
Inferior
Aorta
Splenic
vein
Labeled: LIVER SAG LT LOBE
2. Longitudinal image of the LEFT LOBE to include the diaphragm
and caudate lobe.
Diaphragm
Superior
vein
Left lobe
Anterior
Ligamentum
venosum
Inferior
Inferior
vena
cava
Diaphragm
Labeled: LIVER SAG LT LOBE
Caudate lobe
Caudate
lobe
Splenic
vein
CHAPTER 6 Liver Scanning Protocol 111
Posterior
Portal vein
Gallbladder
transmission
3. Longitudinal image of the RIGHT LOBE to include the IVC where
it passes through the liver.
Right lobe
Hepatic
Hepatic
vein
Diaphragm
Inferior
vena
cava
Diaphragm
vein
Right lobe
Anterior
Right renal artery
Labeled: LIVER SAG RT LOBE
Bowel
Stomach
InferiorSuperior
Caudate lobe
4. Longitudinal image of the RIGHT LOBE to include the main
lobar fissure, gallbladder, and portal vein.
Main lobar
fissure
Right lobe
Superior
Portal
vein
Diaphragm
Anterior
Posterior
Labeled: LIVER SAG RT LOBE
Bowel
Inferior
Through
112 PART III Abdominal Scanning Protocols
Posterior
Anterior
Posterior
Anterior
5. Longitudinal image of the RIGHT LOBE to include part of the
right kidney for parenchyma comparison.
Right lobe
Superior
Diaphragm
Inferior
Right
kidney
Labeled: LIVER SAG RT LOBE
6. Longitudinal image of the RIGHT LOBE to include the dome and
the adjacent pleural space.
Diaphragmatic
motion
Superior
Pleural
space
Right lobe
Inferior
Dome
Diaphragm
Labeled: LIVER SAG RT LOBE
CHAPTER 6 Liver Scanning Protocol 113
Anterior
tL
Left lobe
vena cava
Left lobe
vein
Liver • Axial Images
Transverse Plane • Transabdominal Anterior Approach
7. Axial image of the LEFT LOBE to include its lateral margin.
liver
Righ
Portal
vein
Inferior
Posterior
Labeled: LIVER TRV LT LOBE
8. Axial image of the LEFT LOBE to include the ligamentum teres.
Ligamentum
teres
Portal splenic
confluence
Portal
vein
Inferior
vena cava
Anterior
Superior
mesenteric
Aorta
artery
eft
Aorta
Vertebra
Pancreas
Bowel
LeftRight
Side
wall shadow
Posterior
Spine
Labeled: LIVER TRV LT LOBE
NOTE: Depending on liver size and shape, it may be possible to take
one axial image that includes the left lobe’s lateral margin and the ligamentum teres. If so, label: LIVER TRV LT LOBE
Left renal
Splenic
vein
114 PART III Abdominal Scanning Protocols
Posterior
c
Middle hepatic
Posterior
Anterior
Left portal
9. Axial image of the RIGHT LOBE to include the hepatic veins.
vein
Liver
right
lobe
Right
hepatic vein
Anterior
Left hepati
vein
LeftRight
Inferior
vena cava
Diaphragm
Labeled: LIVER TRV RT LOBE
10. Axial image of the RIGHT LOBE to include the right and left
branches of the portal vein.
Right
portal vein
Right lobe
Inferior
vena cava
vein
LeftRight
Aorta
Right kidney
Labeled: LIVER TRV RT LOBE
Spine
CHAPTER 6 Liver Scanning Protocol 115
Common
rior
Posterior
r
Bowel
11. Axial image of the RIGHT LOBE to include the main portal vein
entering the porta hepatis.
duct
Liver
right lobe
Superior
Inferior
vena cava
Anterior
Posterior
Labeled: LIVER TRV RT LOBE
12. Axial image of the RIGHT LATERAL INFERIOR LOBE.
Right lobe
Anterior
Pancreas
head
Bowl
Infe
Main
portal vein
LeftRight
Labeled: LIVER TRV RT LOBE
Gallbladde
Right kidney
116 PART III Abdominal Scanning Protocols
Posterior
Right lobe
13. Axial image of the RIGHT LATERAL LOBE to include the
dome and the adjacent pleural space.
Labeled: LIVER TRV RT LOBE
Required Images When the Liver is Part of Another Study
Anterior
LeftRight
Pleural
space
Diaphragm
• Required images of the liver are always the same, whether it is the
primary area of interest or part of another study.
Review Questions
Answers on page 629.
1. The sonographic appearance of normal liver parenchyma may be
described as
a) hypoechoic relative to normal renal cortex.
b) heterogeneous with low-level echoes.
c) homogeneous with medium-level echoes.
d) hyperechoic relative to the pancreas.
2. The vascular branches seen scattered throughout the liver paren-
chyma are
a) pulmonary and hepatic veins.
b) portal veins.
c) hepatic veins.
d) portal and hepatic veins.
CHAPTER 6 Liver Scanning Protocol 117
3. The portal vein is formed by the confluence of the
a) splenic vein, and superior and inferior mesenteric veins.
b) superior and inferior mesenteric veins.
c) splenic vein, pancreatic duct, and common bile duct.
d) splenic and superior mesenteric veins.
4. The portal triad is found at the level of the ______________, and
consists of the _______________.
a) porta hepatis; hepatic artery, bile duct, and portal vein
b) confluence of the portal vein; gastroduodenal artery, bile duct,
and portal vein
c) porta hepatis; hepatic artery, gastroduodenal artery, and IVC
d) porta hepatis; cystic duct, bile duct, and portal vein
5. The liver is intraperitoneal except for interruptions at the gallblad-
der fossa, porta hepatis, and falciform ligament, portions around
the IVC, and _________
a) the superior surface.
b) the anterior surface.
c) the bare area.
d) Glisson’s capsule.
6. The liver is divided into lobes according to _________ and into
segments according to _________.
a) function; anatomy
b) function; biliary drainage
c) anatomy; function
d) blood supply; biliary drainage
7. The main lobar fissure of the liver
a) subdivides the right lobe into anterior and posterior portions.
b) runs between the right branch of the portal vein and the neck of
the gallbladder.
c) forms the left boundary of the medial portion of the left lobe.
d) runs between the left branch of the portal vein and the neck of
the gallbladder.
8. The caudate lobe is located on which surface of the liver?
a) Inferior
b) Posterior
c) Anterior
d) Superior
9. The right, left, and middle hepatic veins
a) converge at the porta hepatis.
b) drain the blood from the right lobe of the liver.
c) empty into the IVC.
d) empty into the main portal vein.
118 PART III Abdominal Scanning Protocols
10. A longitudinal section of the right and left branches of the portal
vein is seen in a
a) sagittal scanning plane.
b) longitudinal view of the right lobe of the liver.
c) transverse scanning plane.
d) axial section of the left lobe of the liver.
11. Anteroposterior measurement of the adult liver should not be larger
than
a) 12 cm.
b) 15 cm.
c) 20 cm.
d) 25 cm.
12. Which ligament separates the left lobe from the caudate lobe?
a) Coronary
b) Venosum
c) Falciform
d) Hepatoduodenal
13. Segmental lobar anatomy divides the liver into ____ lobes.
a) Three
b) Four
c) Six
d) Eight
14. The right lobe of the liver is divided into anterior and posterior
segments by the _________
a) middle hepatic vein.
b) right hepatic vein.
c) right portal vein.
d) main portal vein.
15. The normal liver should have a/an ____________ sonographic
appearance.
a) homogeneous
b) heterogeneous
c) low-level echogenicity
d) anechoic
16. Hepatic veins ___________ in size as they drain toward the IVC.
a) remain the same
b) increase
c) decrease
17. What percentage of the total blood flow to the liver does the portal
system supply?
a) 30
b) 50
c) 75
d) 90