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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 9 Renal Scanning Protocol 179
2. When the kidney is identified, resolve the long axis, then very
slightly rock the transducer superior to inferior while sliding
the transducer anteriorly (toward the patient’s front), scanning
through and beyond the kidney margin.
Evaluate the perirenal region as you scan through it.
3. Move the transducer back onto the kidney. Slowly rocking and
sliding move posteriorly (toward the patient’s back), scanning
through and beyond the right kidney.
Evaluate the perirenal region as you scan through it.
Right Kidney • Axial Survey
Transverse Plane • Transabdominal Anterior Approach
1. Still in the sagittal scanning plane, relocate the long axis of the right
kidney. Slowly rotate the transducer 90 degrees into the transverse
plane. The rounded, axial section of the kidney will come into view.
LT
RT
NOTE: As an alternative, you can start the axial survey in the transverse
plane. Begin scanning with the transducer perpendicular, just inferior to
the costal margin of the medial angle of the ribs. With the patient holding his or her breath, move the transducer in right lateral and inferior
sections until the kidney is located.
LT
RT
180 PART III Abdominal Scanning Protocols
2. When the kidney is identified, slowly move the transducer slightly
superior and medial, or inferior and lateral, to locate the mid portion of the kidney and visualize the renal hilum. It may be necessary to very slightly twist/rotate the transducer, first one way then
the other, to slightly oblique the scanning plane to adequately
resolve the hilum.
3. From the hilum, slightly rock the transducer side to side while
slowly sliding the transducer superior and medial through and
beyond the superior pole of the kidney.
Evaluate the perirenal region as you scan through it.
LT
RT
4. Continue rocking, and move the transducer back onto the superior
pole. Slowly slide the transducer inferior and right lateral through
the mid portion and the inferior pole of the kidney. Scan through
and beyond the inferior pole.
Evaluate the perirenal region as you scan through it.
LT
RT
NOTE: The axial survey of the right kidney can be performed from a
transverse plane, right lateral approach. This approach can be performed
with the patient supine, but it is usually easier to scan with the patient in
a left lateral decubitus position.
1. Begin scanning with the transducer perpendicular, at the midline and just superior to the iliac crest. Have the patient hold his
or her breath while you move or angle the transducer superior to
inferior or scan intercostally if necessary to locate the kidney.
CHAPTER 9 Renal Scanning Protocol 181
2. When the kidney is identified, resolve the renal hilum, then
very slightly rock the transducer side to side while sliding the
transducer superiorly through and beyond the kidney margin.
Evaluate the perirenal region as you scan through it.
3. Move the transducer back onto the kidney. Slowly rocking and
sliding move inferiorly, scanning through and beyond the right
kidney.
Evaluate the perirenal region as you scan through it.
Left Kidney • Longitudinal Survey
Coronal Plane • Left Lateral Approach
NOTE: Although this approach can be performed with the patient
supine, it is generally easier with the patient in the right lateral decubitus position. Imaging quality might be improved by placing a sponge or
rolled towel under the patient’s right side to open up the rib spaces on
the patient’s left.
1. Begin scanning with the transducer perpendicular, midcoronal
plane, just superior to the iliac crest.
NOTE: If the kidney is not seen in the midcoronal plane, try approaches
just to the right and left of the midline.
182 PART III Abdominal Scanning Protocols
2. Have the patient take in a deep breath and hold it while you move or
angle the transducer superior to inferior to locate the kidney. When
the kidney is located, very slightly twist/rotate the transducer, first
one way then the other (to oblique the scanning plane according to
the vertical oblique lie of the right kidney), to resolve the long axis.
3. Once the long axis is determined, very slightly rock the transducer
superior to inferior while slowly sliding the transducer anteriorly
(toward the patient’s front), scanning through and beyond the
kidney margin.
Evaluate the perirenal region as you scan through it.
4. Move the transducer back onto the kidney. Slowly rocking and
sliding, move posteriorly (toward the patient’s back), scanning
through and beyond the left kidney.
Evaluate the perirenal region as you scan through it.
NOTE: The longitudinal survey of the left kidney may have to be performed intercostally, depending on body habitus and the position of the
kidney. Begin with the transducer perpendicular, midcoronal plane, in
the first inferior intercostal space. Have the patient hold his or her breath
while you move superiorly through the adjacent intercostal spaces to
evaluate the entire kidney. Varying respiration and angling the transducer
CHAPTER 9 Renal Scanning Protocol 183
within the intercostal spaces can aid evaluation. In some cases, only the
superior pole will have to be evaluated intercostally.
Left Kidney • Axial Survey
Transverse Plane • Left Lateral Approach
1. Still in the coronal scanning plane, relocate the long axis of the left
kidney. Slowly rotate the transducer 90 degrees into the plane. The
round to oval axial section of the kidney will come into view.
NOTE: As an alternative, you can start the axial survey in the transverse
plane. Begin scanning with the transducer perpendicular, at the midline
and just superior to the iliac crest. Have the patient hold his or her breath
while you move the transducer superior to inferior to locate the kidney.
184 PART III Abdominal Scanning Protocols
2. When the kidney is identified, slowly move the transducer slightly
medial, then very small movements superior and inferior to locate
the midportion of the kidney and visualize the renal hilum. It may
be necessary to very slightly twist/rotate the transducer, first one
way then the other, to oblique the scanning plane to adequately
resolve the hilum.
3. From the hilum, slightly rock the transducer side to side while
slowly sliding the transducer superior and through and beyond the
superior pole of the kidney.
Evaluate the perirenal region as you scan through it.
4. Continue rocking, and move the transducer back onto the superior
pole. Slowly slide the transducer inferiorly through the mid portion and the inferior pole of the kidney. Scan through and beyond
the inferior pole.
Evaluate the perirenal region as you scan through it.
NOTE: The axial survey of the left kidney may have to be performed
intercostally, depending on body habitus and the position of the kidney.
Begin with the transducer perpendicular, at the midline, in the first inferior intercostal space. Have the patient hold his or her breath while you
move superiorly through the adjacent intercostal spaces to evaluate the
entire kidney. Varying respiration and angling the transducer within the
intercostal spaces can aid evaluation. In some cases, only the superior
pole will have to be evaluated intercostally.
CHAPTER 9 Renal Scanning Protocol 185
Anterior
Posterior
Kidneys Required Images
NOTE: The required images are a small representation of what a sonog-
rapher visualizes during a study. Therefore, the images should provide
the interpreting physician with the most telling and technically accurate
information available.
Right Kidney • Longitudinal Images
Sagittal Plane • Transabdominal Anterior Approach
1. Image of the right kidney LONG AXIS with superior to inferior
measurement.
Labeled: RT KID SAG LONG AXIS
2. Same image as number 1 without calipers.
Superior
Diaphragm
Liver
Inferior
Inferior
pole
Sinus
Midportion
Cortex
Superior
pole
Labeled: RT KID SAG LONG AXIS
186 PART III Abdominal Scanning Protocols
Anterior
Posterior
r
3. Image of the right kidney LONG AXIS with superior to inferior
measurement.
Inferior pole
Superior
Sinus
Diaphragm
Liver
Superior
pole
Labeled: RT KID SAG LONG AXIS
4. Same image as number 3 without calipers.
Inferio
Psoas
muscle
Midportion
Cortex
Labeled: RT KID SAG LONG AXIS
NOTE: In many cases superior and/or inferior pole definition is
sacrificed to achieve the long axis. If so, take those images here and
label accordingly.
CHAPTER 9 Renal Scanning Protocol 187
Anterior
Posterior
Sinus
Anterior
r
5. Longitudinal image of the right kidney SUPERIOR POLE.
Superior
Diaphragm
Labeled: RT KID SAG SUP POLE
6. Longitudinal image of the right kidney INFERIOR POLE.
Superior
Liver
Inferior
Liver
Superior
pole
Cortex
Inferio
Inferior
pole
Sinus
Labeled: RT KID SAG INF POLE
Cortex
Posterior
188 PART III Abdominal Scanning Protocols
Anterior
Posterior
n
Psoas
Posterior
l
n
Medullary
7. Longitudinal image of the right kidney JUST MEDIAL TO THE
LONG AXIS.
Superior
Medullary pyramids
Liver
muscle
Inferior
Medial
portio
Diaphragm
Cortex
Spine
Labeled: RT KID SAG MED
8. Longitudinal image of the right kidney JUST LATERAL TO THE
LONG AXIS to include part of the liver for parenchyma comparison.
pyramids
Superior
Diaphragm
Anterior
Liver
Sinus
Cortex
Latera
portio
Inferior
Quadratus
lumborum
muscle
Labeled: RT KID SAG LAT