By Bates J.
A entire consultant to belly ultrasound, together with uncomplicated anatomy, approach and ultrasound appearances including the commonest pathological methods. could be hugely illustrated with top of the range scans, many in color.
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Additional resources for Abdominal Ultrasound: How, Why and When
Pathology or artefact? Sometimes the gallbladder may contain some echoes of doubtful significance, or be insufficiently distended to evaluate accurately. A rescan, after a meal followed by further fasting, can be useful. 30 (A) A folded gallbladder is difficult to examine with the patient supine. (B) Turning the patient decubitus, right side raised, unfolds the gallbladder, enabling the lumen to be satisfactorily examined. 29 The gallbladder: (A) LS, (B) TS. (C) False appearance of wall thickening is produced (arrow) when the angle of scan is not perpendicular to the gallbladder wall in TS.
Occasionally a fistula forms between the hepatic duct and the gallbladder due to erosion of the duct wall by the stone. 12 (A) Anomalous insertion of the cystic duct (arrow) into the lower end of the CBD. (B) Appearances of case in (A) are confirmed on ERCP. A stone is also present in the duct. 11B). If the condition is not promptly diagnosed, recurring cholangitis leading to secondary biliary cirrhosis may result. On ultrasound the gallbladder may be either enlarged or contracted and contain debris.
In most cases the single, main right hepatic vein (RHV) flows directly into the IVC, and the middle and left have a common trunk. In 15–35% of patients the left hepatic vein (LHV) and middle hepatic vein (MHV) are separate. This usually has no significance to the operator. However, it may be a significant factor in planning and performing hepatic surgery, especially tumour resection, as the surgeon attempts to retain as much viable hepatic tissue as possible with intact venous outflow (Fig. 4 Haemodynamics of the liver Pulsed and colour Doppler to investigate the hepatic vasculature are now established aids to diagnosis in the upper abdomen.
Abdominal Ultrasound: How, Why and When by Bates J.