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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 319
Posterior
processes
Anterior spinal
processes
Amniotic
Lumbar
Stomach
Limb
12. Axial image of the THORACIC SPINE.
Labeled: T SPINE
13. Axial image of the LUMBAR SPINE.
Placenta
Limb
Placenta
Kidney
Amniotic
cavity/fluid
Shoulder
Throracic
vertebrae
Scapulae
vertebrae
spinal
cavity/fluid
Kidney
Labeled: L SPINE
Limb
320 PART IV Pelvic Scanning Protocols
Right ventricle
Left atrium
Right ventricular
artery
pulmonary
14. 4-CHAMBER VIEW of the fetal heart to include its location
within the thorax.
RVOT
Apex of
the heart
Left
ventricle
Mitral
valve
Atrial
septum
Left
Tricuspid valve
Right
Right
atrium
Rib
Descending
aorta
Anterior
Left
ventricular
septum
Foramen
ovalae
Spine
Posterior
Labeled: HEART
15. Optional image showing the normal RIGHT VENTRICULAR
OUTFLOW TRACT.
Pulmonary
valve leaflet
Placenta
Right
atrium
Left
atrium
outflow tract
Hand
Pulmonary
valve leaflet
Main
pulmonary
artery
Left
Amniotic
fluid
Labeled: RVOT
Aorta
Descending
aorta
Thorax
artery
Right
pulmonary
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 321
aorta
ventricle
Heart muscle
outflow tract
ventricle
Acoustic shadow from spine
16. Optional image showing the normal LEFT VENTRICULAR
OUTFLOW TRACT.
Interventricular
LVOT
Diaphragm
Stomach
Spleen
Labeled: LVOT
17. Axial image of FETAL KIDNEYS together.
Portal vein
Liver
septum
Liver
Descending
Right kidney
Left
Limb
Right
Aorta
Left ventricular
Vertebra
Left kidney
Labeled: KIDNEYS
NOTE: In cases where the kidneys cannot be imaged together because
of fetal position or movement, take separate axial images of each kidney
and label accordingly.
Amniotic
fluid
322 PART IV Pelvic Scanning Protocols
Placenta
Uterus
Stomach
18. Longitudinal image of the RIGHT KIDNEY.
Labeled: RT KID
19. Longitudinal image of the LEFT KIDNEY.
Amniotic
cavity/fluid
Right
kidney
Amniotic
cavity/fluid
Uterus
Spine
Amniotic
cavity/fluid
Left
kidney
Labeled: LT KID
Spine
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 323
Stomach
Placenta
Muscle
l
20. Image of the URINARY BLADDER.
Urinary bladder
Uterus
Amniotic
fluid
Limbs
Uterus
Labeled: UR BLADDER
21. Image of the UMBILICAL CORD INSERTION SITE on the
anterior abdominal wall.
Placenta
Amniotic
cavity/fluid
Vein
Artery
Labeled: CORD
Amniotic
fluid
Umbilica
cord
insertion
NOTE: If the insertion site image does not distinguish the 3 vessels of
the cord, take an additional image of the cord to demonstrate the 3 vessels
and label accordingly.
324 PART IV Pelvic Scanning Protocols
22. A magnified view of an axial section of the 3-vessel UMBILICAL
CORD.
Limb
Wharton’s
jelly
Labeled: CORD
23. Image of the STOMACH if visualized.
Placenta
Umbilical
portion of
left portal
vein
Umbilical
arteries
Placenta
Umbilical
cord
Amniotic
cavity/fluid
Umbilical
vein
Vertebra
Stomach
Labeled: STOMACH
NOTE: The image of the stomach is not necessary if the stomach was
documented on any other image.
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 325
eskin
Thigh
c
Minor
Major
24. Image of GENITALIA. A and B provided to aid identification of
the different genitalia: (A) Image of male genitalia. (B) Image of
female genitalia.
Limb
Te sticle
Scrotum
Glans
Penis
For
A
Labeled: GENITALIA
labium
Vaginal
cleft
Placenta
Myometrium
labium
Amnioti
fluid
Thighs
B
Labeled: GENITALIA
326 PART IV Pelvic Scanning Protocols
fluid
Lateral
ometrium
Spine
Fetal profile
25. Longitudinal image of the FETUS to include the DIAPHRAGM.
Placenta
Diaphragm
Abdomen
Aorta
Heart
Thorax
Labeled: DIAPHRAGM
NOTE: Because of the obvious nature of the fetal measurements, specifics are not included as part of the film labeling for the following
measurement images.
26. BIPARIETAL DIAMETER (BPD) image at the level of the
thalamus and the cavum septum pellucidi. Measurement is from
the outside of the near cranium to the inside of the far cranium (leading edge to leading edge).
Frontal
horns
Cavum septum
pellucidum
Placenta
Amniotic
ventricle
Third
ventricle
Thalamus
My
Lateral fissure
CHAPTER 13 Obstetrical Scanning Protocol for First, Second, and Third Trimesters 327
the cerebellum
Calipers for
Cerebellum
Amniotic fluid
Calipers for
bone
Amniotic fluid
27. CEREBELLUM with measurement.
Occipital
28. CISTERNA MAGNUM with measurement.
measurement of
Hemispheres of
the cerebellum
bone
Vermis of
Calipers for
cisterna
magnum
cerebellar
measurement
Placenta
Parietal bone
Cerebral
peduncles
Cisterna
magnum
Occipital
bone
Placenta
29. NUCHAL FOLD (done between 16 and 24 weeks) with measurement.
measurement of
nuchal fold
Nuchal
fold
Occipital
Cisterna magnum
Cerebellum
Thalamus
Placenta
328 PART IV Pelvic Scanning Protocols
fluid
Lateral
m
of the calvarium
Medial wall
NOTE: The measurement of the nuchal fold is not always routinely performed but should be considered for the fetus of patients over age 35
or when a lower-than-normal serum AFP level has been detected in the
mother. The extra fold of soft tissue visualized at the back of the neck is
considered a sonographic marker for the second trimester detection of
Down syndrome.
30. HEAD CIRCUMFERENCE image at the same level as the biparietal diameter or use the BPD image. Measurement is around the
outline of the cranium. Up-to-date ultrasound equipment provides
tracking balls to trace the cranium or calipers that open to outline the cranium.
Frontal
horns
Cavum septum
pellucidum
31. Image of the CHOROID PLEXUS.
Choroid plexus
Falx
cerebrei
Placenta
Amniotic
ventricle
Lateral fissure
Third
ventricle
Thalamus
Tentoriu
Myometrium
of the lateral
ventricle
Placenta
Amniotic fluid
Occipital-parietal suture