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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 10 Spleen Scanning Protocol 209
Spleen • Axial Survey
Transverse Plane • Left Lateral Approach
1. Still in the coronal scanning plane, relocate the long axis of the
spleen. Slowly rotate the transducer 90 degrees into the transverse
scanning plane. Move into adjacent intercostal spaces as necessary
and also slightly rotate/twist the transducer, first one way then the
other, until the anterior and posterior margins of the spleen are
resolved and the hilum is visualized anteromedially.
2. Now move or angle the transducer superiorly, scanning through
and beyond the superior margin of the spleen. Note the adjacent
pleural space.
3. Move back onto the spleen and move or angle the transducer inferiorly, scanning through and beyond the inferior margin of the
spleen.
210 PART III Abdominal Scanning Protocols
Medial
Medial
Spleen
Rib shadows
Spleen 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.
Spleen • Longitudinal Images
Coronal Plane • Left Lateral Approach
1. LONG AXIS image of the spleen.
LT
RT
Long axis
of spleen
Superior
Diaphragm
Lateral
Inferior
Left kidney
Labeled: SPLEEN COR LONG AXIS
2. SUPERIOR LONGITUDINAL image of the spleen (to include the
adjacent pleural space).
LT
RT
Superior
Pleural
space
Lateral
Inferior
Labeled: SPLEEN COR SUP
Diaphragm
CHAPTER 10 Spleen Scanning Protocol 211
Medial
rior
Lateral
Medial
r
3. INFERIOR LONGITUDINAL image of the spleen (to include part
of the left kidney for parenchyma comparison).
LT
RT
Spleen
Superior
Pleural
space
Lateral
Labeled: SPLEEN COR INF
Spleen • Axial Images
Transverse Plane • Left Lateral Approach
4. AXIAL image of the spleen (to include both anterior and posterior
margins).
LT
Infe
Left
kidney
RT
Anterior
Splenic
hilum
Labeled: SPLEEN LT TRV
Posterio
Diaphragm
212 PART III Abdominal Scanning Protocols
Medial
r
Spleen
Rib shadow
Lateral
Medial
r
5. AXIAL image of the spleen (to include the anterior margin and
splenic hilum).
LT
RT
Anterior
Lateral
Posterio
Splenic
hilum
Diaphragm
Labeled: SPLEEN LT TRV ANT
6. AXIAL image of the spleen (to include the posterior margin).
LT
RT
Anterior
Spleen
Posterio
Splenic
hilum
Labeled: SPLEEN LT TRV POST
Diaphragm
CHAPTER 10 Spleen Scanning Protocol 213
Required Images When the Spleen is Part of Another Study
The required images are the same as the above except that:
1. The longitudinal images of the spleen that include the adjacent
pleural space and part of the left kidney may be combined into one
image if all of the structures are clearly seen. If so, label the image:
SPLEEN COR
In some cases these structures may also be seen on the long axis
image. If so, label the image:
SPLEEN COR LONG AXIS
2. Only one axial image of the spleen is necessary as long as the anterior and posterior margins of the spleen are well visualized. If so,
label the image:
SPLEEN LT TRV
Review Questions
Answers on page 629.
1. The sonographic appearance of the normal spleen is
a) heterogeneous, midgray, interrupted by multiple anechoic vas-
cular branches.
b) homogeneous, midgray, isosonic or hypoechoic relative to the liver.
c) homogeneous, midgray, isosonic or hyperechoic relative to the
liver.
d) homogeneous, midgray, lobular outer contour.
2. The spleen is
a) anterior to the pancreas tail, lateral to the stomach, splenic vein
and splenic artery.
b) retroperitoneal in the left hypochondrium.
c) intraperitoneal in the left hypochondrium.
d) lateral to the pancreas tail, anterior to the stomach, anterior to
the left kidney.
3. The long axis of the spleen
a) is only resolved from a posterior approach.
b) is seen in a left coronal oblique plane.
c) is seen in a transverse plane.
d) cannot be resolved intercostally.
4. In most cases, the best patient position to visualize the spleen is
a) right posterior oblique.
b) left lateral decubitus.
c) right lateral decubitus.
d) left posterior oblique.
5. Accessory spleen is
a) not sonographically distinguishable.
b) splenic tissue found separate from the spleen.
c) abnormal if visualized sonographically.
d) a rare duplicate spleen.
214 PART III Abdominal Scanning Protocols
6. The spleen is part of the reticuloendothelial system and is
a) a large mass of lymphatic tissue.
b) essential to life.
c) the body’s largest manufacturer of insulin cells.
d) responsible for hormone production.
7. The splenic artery
a) runs directly anterior to the splenic vein.
b) is visualized longitudinally in a sagittal oblique plane.
c) is visualized longitudinally in a left coronal plane.
d) runs superior and slightly anterior to the splenic vein.
8. A scanning technique to help resolve the structures at the splenic
hilum is to
a) use very light pressure within the intercostal space.
b) angle the transducer anteriorly while the patient performs the
Valsalva maneuver.
c) very slightly rotate/twist the transducer, first one way and then
the other.
d) angle the transducer superiorly while the patient performs the
Valsalva maneuver.
9. The spleen is
a) ovoid with a convex superior surface and concave inferomedial
surface.
b) ovoid with lobulated surfaces.
c) ovoid with a concave superior surface.
d) ovoid with a convex inferior surface.
10. The major functions of the spleen are
a) red blood cell and platelet destruction, defense, hematopoiesis,
blood reservoir.
b) defense, hematopoiesis, red blood cell production, blood reservoir.
c) defense, insulin production, blood reservoir.
d) red blood cell and platelet destruction, defense, hormone
production, blood reservoir.
11. When scanning near the splenic hilum, what structure will you
encounter?
a) Left kidney
b) Left lobe of the liver
c) Splenic vein
d) Duodenum
12. What vein does the splenic vein drain into?
a) Portal vein
b) Left renal vein
c) IVC
d) Inferior mesenteric vein
CHAPTER 10 Spleen Scanning Protocol 215
Medial
rior
Lateral
Medial
r
13. The splenic vein joins the SMV and forms the __________________.
a) hepatic vein
b) gastric vein
c) portal vein
d) inferior mesenteric vein
14. This is a coronal scanning plane image of the spleen. Label the
accompanying illustration.
LT
RT
Superior
Lateral
15. This is a transverse left lateral approach image of the spleen. Label
the accompanying illustration.
LT
RT
Anterior
Infe
Posterio
216 PART III Abdominal Scanning Protocols
Medial
rior
16. This is a coronal scanning plane image of the spleen. Label the
accompanying illustration.
LT
RT
Superior
Lateral
Infe
PART IV
PELVIC SCANNING
PROTOCOLS
217
Fallopian tube
Uterus
Urinary bladder
Symphysis pubis
Ovary
Vagina
Uterine cavity
Body
Cervix
Rectum
Female Pelvis
Fallopian tube
Fundus
Ovary
Ovarian ligament
Internal os
Cervical cavity
External os
Vagina
Anatomy of Uterus, Uterine Tubes, Ovaries, and Vagina