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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 359
Anterior
Left
(rectum)
Prostate • Axial Images
Transverse Plane • Rectal Approach
1. Axial image of the SEMINAL VESICLES.
Urinary
bladder
Right
Seminal
vesicle
Posterior
Labeled: ER TRV SEM V
(“ER” indicates endorectal)
NOTE: Because of the limited field of view, both seminal vesicles may
not be entirely visible on a single view. If so, take these additional images:
2. Axial image of the RIGHT SEMINAL VESICLE to include its
right lateral margin.
PROSTATE
GLAND
TRANSV
SEMINAL VESICLE
RT
Right seminal
vesicle
Right Left
Anterior
Posterior
(rectum)
Labeled: ER TRV SEM V RT
Urinary
bladder
360 PART IV Pelvic Scanning Protocols
Left
Anterior
(rectum)
Anterior
Left
(rectum)
3. Axial image of the LEFT SEMINAL VESICLE to include its left
lateral margin.
PROSTATE
TRANS
BASE
Urinary
LT SEMINAL VESICLE
bladder
Right
Labeled: ER TRV SEM V LT
4. Axial image of the BASE of the prostate.
Left seminal
vesicle
Posterior
Base of
prostate
Right
Labeled: ER TRV BASE
Posterior
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 361
Anterior
Left
(rectum)
PROSTATE
Left
(rectum)
5. Axial image of the MID prostate.
TRANS
MID
Right
Labeled: ER TRV MID
6. Axial image of the APEX of the prostate.
TRAN APEX
Labeled: ER TRV APEX
Right
Posterior
Anterior
Posterior
Mid
prostate
Apex of
prostate
362 PART IV Pelvic Scanning Protocols
Inferior
Anterior
(rectum)
Inferior
(rectum)
Prostate • Longitudinal Images
Sagittal Plane • Rectal Approach
7. LONGITUDINAL MIDLINE image of the prostate.
GLAND
SAG ML
URINARY
BLADDER
URETHRA
Labeled: ER SAG ML
Urinary
bladder
Urethra
Prostate
Superior
Posterior
PROSTATE
GLAND
SAG RT
8. Longitudinal image of the RIGHT LATERAL portion of the
prostate gland including the right seminal vesicle.
Anterior
Right seminal
vesicle
Superior
PROSTATE
GLAND
Posterior
Prostate
Labeled: ER SAG RT
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 363
Inferior
Transducer
9. Longitudinal image of the LEFT LATERAL portion of the prostate
gland including the left seminal vesicle.
PROSTATE
GLAND
SAG LT
PROSTATE
GLAND
Labeled: ER SAG LT
Scrotum Survey
NOTE: Use the following survey steps for both testes.
Scrotum • Longitudinal Survey
Sagittal Plane • Anterior Approach
Superior
Urinary
bladder
Anterior
Left seminal
vesicle
Prostate
gland
Posterior
(rectum)
NOTE: Evaluation of the testis begins with a survey of the spermatic cord
with the patient in normal respiration followed by having the patient
perform the Valsalva maneuver to rule out varioceles.
1. Begin scanning with the transducer perpendicular at the superior
midline portion of the testis at the level of the spermatic cord. The
patient should be at normal respiration.
Penis
Testis
Head of epididymis
Tail of epididymis
Tape
Spermatic cord
364 PART IV Pelvic Scanning Protocols
Transducer
Transducer
Testis
s
Head of epididymis
Tail of epididymis
2. Keep the transducer perpendicular at the level of the spermatic
cord and slowly slide the transducer medially through and beyond
the cord.
Testis
3. Scan back through the medial portion of the spermatic cord to
mid testis. Keeping the transducer perpendicular, slowly slide the
transducer laterally through and beyond the cord.
Penis
Tape
Spermatic cord
Head of epididymis
Tail of epididymis
Penis
Tape
Spermatic cord
Head of epididymi
Tail of epididymis
4 to 6. Repeat the above survey steps of the spermatic cord while
the patient performs the Valsalva maneuver.
7. Keep the transducer perpendicular and return to the mid portion
of the testis.
Tape
Transducer
Penis
Spermatic cord
Testis
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 365
Spermatic cord
Tail of epididymis
Spermatic cord
NOTE: The spermatic cord, epididymal head, and the superior and inferior margins of the testis should be visible on longitudinal sections. If
not, move the transducer superior and inferior as necessary to evaluate
all of the anatomy.
8. Slowly slide the transducer medially through and beyond the
scrotal sac.
Tape
Transducer
Testis
Penis
Head of
epididymis
NOTE: Note scrotal skin thickness.
9. Move back to mid testis. Keep the transducer perpendicular; slowly
scan laterally through and beyond the testis and scrotal sac.
Tape
Transducer
Tail of epididymis
Penis
Head of
epididymis
Testis
366 PART IV Pelvic Scanning Protocols
Transducer
epididymis
Tail of epididymis
Transducer
Tail of epididymis
epididymis
Spermatic cord
Scrotum • Axial Survey
Transverse Plane • Anterior Approach
NOTE: Evaluation of the testis begins with a survey of the spermatic cord
with the patient in normal respiration followed by having the patient
perform the Valsalva maneuver to rule out varioceles.
1. Begin scanning with the transducer perpendicular at the superior
portion of the testis at the level of the spermatic cord. The patient
should be at normal respiration.
Testis
Penis
Tape
Spermatic
cord
Head of
2. Keep the transducer perpendicular at the level of the spermatic
cord and slowly slide the transducer superiorly, scanning through
and beyond the cord.
Head of
Testis
Penis
Tape
CHAPTER 14 Male Pelvis Scanning Protocol for the Prostate Gland, Scrotum, and Penis 367
Testis
Tail of epididymis
Tape
Spermatic
Tail of epididymis
Spermatic cord
3. Scan back through the superior portion of the spermatic cord to
mid cord. Keeping the transducer perpendicular, slowly scan inferiorly through and beyond the cord.
Transducer
Penis
Head of
epididymis
cord
4 to 6. Repeat the above survey steps of the spermatic cord while
the patient performs the Valsalva maneuver.
7. Keep the transducer perpendicular and return to the mid portion
of the testis.
Tape
Transducer
Testis
Penis
Head of
epididymis
NOTE: The medial and lateral margins of the testis should be visible on
axial sections. If not, move the transducer medial and lateral as necessary
to evaluate all of the anatomy.
368 PART IV Pelvic Scanning Protocols
Testis
Tail of epididymis
Spermatic cord
Tail of epididymis
Spermatic cord
Transducer
Spermatic cord
8. Slowly slide the transducer superiorly through the superior portion
of the testis to the head of the epididymis.
9. Keep the transducer perpendicular and continue to move the transducer superiorly through and beyond the head of the epididymis,
the spermatic cord, and scrotal sac.
Tape
Transducer
Penis
Head of
epididymis
Transducer
Penis
Testis
Tape
Head of
epididymis
10. Move back to mid testis. Keep the transducer perpendicular;
slowly scan inferiorly, through the inferior portion of the testis
to the level of the tail of the epididymis.
Penis
Testis
Tape
Head of
epididymis
Tail of epididymis