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BASIC ABDOMINAL
SONOGRAPHY:
A PROCEDURAL
OVERVIEW
John Fatchett II, RDMS, Ultrasound Practitioner
University of Michigan Medical Center
Department of Radiology, Ultrasound Division
INTRODUCTION
The purpose of this paper is to outline basic grayscale
sonographic evaluation of abdominal anatomy in the
average patient. This paper reviews patient preparation
relative to clinical questions, introductory instrumenta-
tion and scanning techniques, transducer selection, and
the anatomy to be evaluated.
PATIENT PREPARATION
A six- to eight-hour minimum fast prior to the exami-
nation is fairly standard patient preparation for abdom-
inal ultrasound in labs.
1
This preparation is for any
exam, or combination of exams, evaluating the liver,
gallbladder, bile ducts, pancreas, and abdominal aorta.
Examinations evaluating only the kidneys and/or spleen
do not require fasting.
Fasting helps to minimize gastrointestinal air, pre-
vent a change in the hepatic vasculature or biliary tree,
and eliminate normal physiologic gallbladder contraction
(Figures 1A1C).
1,2
Any air in the ultrasound beam path
is a limiting factor because the beam cannot penetrate the
air due to the acoustic impedance mismatch between air
and biological tissue (Figure 2).
3-5
Gallbladder contrac-
tion, engorgement of hepatic vasculature, and changes in
the biliary tree due to eating can be false-positive indica-
tors of pathologic conditions such as cholecystitis, portal
hypertension, and biliary obstruction.
FIGURE 1. Figures 1A and 1B represent a con-
tracted gallbladder in a postprandial patient. Note
the thickened, collapsed wall (arrow), which results
in poor visualization of the lumen. Figure 1C de-
picts a well-distended gallbladder in the adequately
prepped patient, NPO for 6-8 hours, allowing ad-
equate evaluation of the lumen, wall, and perichole-
cystic space.
1A
1B
1C
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FIGURE 2. In this patient, the gastric body and
antrum are distended with air, obscuring and pre-
venting visualization of the pancreas and abdom-
inal aorta. Te arrows indicate the leading edge of
the gastric wall.
INTRODUCTORY INSTRUMENTATION
AND SCANNING TECHNIQUES
Although this paper deals chief ly with anatomy, an
abbreviated discussion of machine technique is neces-
sary. The basic utilization of depth, gain, focal zone, and
dynamic range are vital in taking a diagnostic image. The
depth of the image should be set in such a manner that
the target anatomy takes up the majority of the field of
view. For example, when evaluating the liver, you should
be able to see echoes from a few centimeters deeper than
the liver margin. This ensures that you are fully visual-
izing the target structure and also able to evaluate the
immediate vicinity. Setting the depth too far past the
organ of interest decreases the visual resolution of that
organ in that the image size on the display monitor does
not change as you add information (the deeper you image,
the more anatomy is displayed in the same amount of
space), effectively shrinking the target anatomy into the
near field of the displayed image to include the added
deeper information (Figure 3A).
The ultrasound beam has a natural focal zone, but the
machine allows you to electronically focus the beam at
a selected depth. The electronic focal zone should be
placed at or slightly below the target anatomy. Many of
the newer systems have faster and more intricate pro-
cessing to allow multiple focal zones for general abdom-
inal imaging. Previous systems were too slow, and,
typically, sonographers would use only multiple focal
zones when imaging small parts structures that were not
moving. Depending on the imaging system, you may be
able to utilize multiple focal zones without a noticeable
decrease in frame rate.
Overall gain and time gain compensation (TGC) curve
settings are also crucial (Figure 3B). Improper gain set-
tings can mask or mimic pathology. For instance, over-
gaining can add echoes to cystic structures and make
them appear complex or solid. As another example, over-
gaining the liver technique results in an appearance com-
parable to a fatty liver. Under-gaining can significantly
decrease the sensitivity, remove echoes from a complex
structure, and give a simple appearance or lose soft-
tissue information. Using the dynamic range controls
helps when changing the gain control is deleting infor-
mation or adding noise. The ultrasound machine pro-
cesses the returning echo and assigns it a level of gray,
somewhere between black and white, correlating to that
signal's amplitude, or strength. The number of levels of
gray you can display is the dynamic range. Increasing or
decreasing the dynamic range, or levels of gray, simply
reassigns the echoes rather than omitting them or ampli-
fying noise, which is effectively what happens when you
increase or decrease the gain control. The gain settings
should be used to set the image sensitivity; the dynamic
range is for tailoring the image and aiding the diagnostic
capability of the information (Figure 3C).
TRANSDUCER SELECTION
Proper transducer selection for the examination requires
consideration of the body habitus of the patient being
evaluated and the exam to be performed. An increase in
the frequency of a transducer correlates to an increase
in resolution, or increased sensitivity to smaller struc-
tures.
3-5
What is gained in resolution, however, is lost
in depth of penetration because the higher frequencies
are absorbed or attenuated by the tissues more rapidly,
resulting in a loss of signal received.
1,4,5
A decrease in
the transducer frequency gives up some sensitivity, but
gains a greater depth of penetration.
3-5
For the average
adult patient, a 3.5 megahertz (MHz) transducer of a
sector or curved array design is a good place to start.
Linear transducers, by design, are better for superficial
imaging and are not necessarily best where a large field of
view is essential, whereas sector and curved array designs,
with a larger field of view, are better for imaging deeper
and more expansive structures.
3-5
A larger or more dif-
ficult-to-image patient may require a 2.5 MHz, and a
smaller patient may require a 5 MHz, or even a 7 MHz
(usually in pediatric cases).
More than one transducer may also be used. For
instance, a 3.5 MHz for the liver, and if the gallbladder
is more anteriorly located, a 5 MHz (or possibly even a
linear transducer) for this area may provide more detailed
images. The introduction of multiple frequency or wide-
band transducers, in some cases, has decreased the need
for switching probes. You will attain improved depth
penetration along with increased near-field resolution
when using a transducer that uses frequencies ranging
from 3 MHz to 5 MHz, or from 4 MHz to 7 MHz,
rather than a dedicated single-frequency probe. Also,
many manufacturers have implemented a pushbutton
feature allowing a change of the operating frequency of
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the probe without physically switching scan heads. This
feature gives greater f lexibility to the examiner, with
decreased exam time and effort, however minimal that
may be.
FIGURE 3. Figure 3A shows improper depth set-
ting and focal zone placement, along with increased
gain setting, all together decreasing the image quality
and diagnostic capability. Figure 3B shows improved
depth setting, but continued improper focal zone
placement and incorrect TGC setting, again resutling
in poor image quality. Figure 3C shows correct depth
setting, addition of a second focal zone with correct
focal zone placement, and proper gain setting, demon-
strating an appropriate diagnostic image.
THE ANATOMY TO BE EVALUATED
The anatomy to be evaluated depends largely on the
clinical question to be answered. A detailed patient
history to make the investigators aware of previous or
existing medical problems, relevant surgeries, abnormal
lab values, and previous imaging studies are necessary,
along with patient communication. Rather than merely
settling for the instruction "Rule out abdominal pain" on
the requisition, asking a question such as "What con-
cerns bring you here (or to your referring physician)," or
the even more basic "Where/how/when does it hurt," can
bring out more specific questions or target areas.
The option for targeted anatomic evaluation vs complete
upper abdominal imaging will depend upon the imaging
request and the ultrasound lab protocols. The guidelines
followed in one lab, at the University of Michigan, typi-
cally require complete evaluation of the visceral organs in
the upper abdomen, unless a complete evaluation was per-
formed within the last six months, and a targeted follow-
up is requested. For example, a complete abdominal exam
was performed five or six months ago. The patient was
found to have a liver cyst, and follow-up examination has
been requested to observe for changes in the size and/or
composition of the cyst. In this setting, a targeted eval-
uation of the liver and cyst is appropriate. If there are
additional factors such as elevated liver function tests,
however, complete hepatic and biliary system imaging is
warranted, including the hepatic ducts, gallbladder, and
pancreas. A history of general abdominal discomfort or
f lank pain would require the kidneys and spleen to be
added to the picture. Often, you will interrogate each of
the organs for a complete abdominal examination.
Place the transducer in the midline epigastric region
in a longitudinal plane to begin scanning the liver. Start
with the lateral segment of the left lobe, and sweep to
the medial segment and caudate lobe. Pay close attention
to any change in the normal heterogeneous appearance
of the liver parenchyma to evaluate for pathologic signs
such as increased attenuation, irregular borders, masses,
f luid collections, or dilated bile ducts along the portal
veins (Figures 4A4D).
1
Landmarks to look for and
document are the gastroesophageal junction (Figure 5),
proximal abdominal aorta, celiac axis, and superior mes-
enteric artery (Figure 6) posterior to the lateral segment
of the left lobe.
1,3,6
If you are also including the abdominal aorta in the
scan protocol, continue inferiorly in a longitudinal plane
and take anterior to posterior measurements of the
lumen at the proximal, mid, and distal segments down
to the level of the iliac bifurcation, approximately at the
level of the umbilicus and repeat in a transverse plane,
including transverse luminal measurements of the same
areas. The anterior to posterior luminal diameter mea-
surement may be performed in either the longitudinal
or transverse scan planes; your department may have a
predetermined preference (Figures 7A7D). You may
3A
3B
3C
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FIGURE 4. Figure 4A shows the right hepatic lobe, demonstrating normal, homogeneous echotexture. Figure 4B
shows a comparable scan plane in a diferent patient, demonstrating hepatic parenchymal idsease. Note the in-
creased attenuation and degraded image quality. Figure 4C shows normal right hepatic lobe at the porta hepatis,
with a normal appearing main and right portal vein. Figure 4D shows a comparable scan plane in diferent pa-
tient, again demonstrating hepatic parenchymal disease. Note the degraded image quality of the portal vessels and
the inability to identify the surrounding collagenous capsule, as seen in the previous image.
FIGURE 5. Longitudinal view of the left hepatic lobe
and the proximal abdominal aorta, demonstrating the
gastroesophageal junction (single arrow) at the dia-
phragm between the two. Note the collapsed gastric
antrum (double arrow) bordering the inferior margin
of the left lobe, cephalad to the pancreatic body.
FIGURE 6. Longitudinal view of the proximal ab-
cominal aorta, demonstrating the frst anterior
branches, the celiac axis (single arrow) and the su-
perior mesenteric artery (double arrow, immediately
caudal to the celiac axis).
4A
4B
4C
4D
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FIGURE 7. Figure 7A depicts a longitudinal view of the mid-segment of the abdominal aorta. Figure 7B shows
proper caliper placment for the anterior to posterior luminal diameter measurement. Figure 7C is a transverse
view of the mid-segment of the abdominal aorta. Figure 7D depicts proper caliper placement for the transverse
luminal diameter measurement, along with the optional method for performing the anterior to posterior luminal
diameter measurement.
FIGURE 8. Figure 8A is a longitudinal view of the ligamentum teres (arrow), the linear echogenic structure ex-
tending from the inferior aspect of the left portal vein. Figure 8B is a transverse view of the ligamentum teres (arrow).
7A
7B
7C
7D
8A
8B
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FIGURE 9. Figure 9A is a longitudinal view of the ligamentum venosum (arrow), separating the left lobe
from the caudate lobe posteriorly. Te inferior vena cava is noted posterior to the caudate lobe. Figure 9B is
a transverse view of the left hepatic lobe, with the ligamentum venosum (arrow) visualized at the anterior
aspect of the caudate lobe.
FIGURE 10. Figure 10A is a transverse view of the hepatic veins coursing into the inferior vena cava (IVC).
Figure 10B is a transverse view of the main (MPV) and right (RPV) portal vines coursing into the right hepatic
lobe. Note the echogenic collagenous capsule (arrow) surrounding the portal vein in contrast to the hepatic veins.
need to apply downward pressure with the transducer
to push some of the bowel gas out of the scan window,
because the mid and distal segments are completely cov-
ered by bowel.
3
Placing the patient in a right lateral
decubitus position and using the spleen as an acoustic
window can, at times, aid in visualization of the mid
and possibly the proximal segments.
Continuing with the left lobe anatomy and landmarks,
scan and document the ligamentum teres/umbilical vein
remnant (Figures 8A and 8B), which is the division
between the lateral and medial segments of the left lobe,
the ligamentum venosum between the posterior left lobe
and the caudate lobe (Figures 9A and 9B), and the left
hepatic and portal veins.
1,3,6
To distinguish between the
portal vein and hepatic vein, remember that the hepatic
veins are located more superiorly and have poorly defined
borders, becoming larger as they empty into the inferior
vena cava, whereas portal veins branch away from the
porta hepatis in the right lobe and have echogenic collag-
enous walls (Figures 10A and 10B).
3
The inferior vena
cava is visualized posterior to the left medial and caudate
lobes (Figures 9A and 9B). This portion may be evalu-
ated for narrowing or intraluminal mass such as tumor or
thrombus. To finish the longitudinal images of the liver,
change to an intercostal and right lateral approach to eval-
uate the right lobe. In some patients, usually pediatric, the
right lobe can be evaluated from the midline approach,
but this is more the exception than the rule. Here, again,
sweep from medial to lateral. The middle hepatic vein
divides the right from the left lobe superiorly, and, infe-
riorly, the main lobar fissure is another dividing mark,
which can be seen as an echogenic line running from
9A
9B
10A
10B
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FIGURE 11. Longitudinal image of the right hepatic
lobe, demonstrating the main lobar fssure (arrow).
It is the linear echogenic structure running from the
portal vein to the gallbladder neck, where it then opens
into the gallbladder fossa and gallbladder (GB).
FIGURE 12. Te porta hepatis in the right hepatic
lobe, demonstrating the main and right portal veins
posterior to the common hepatic duct (couble arrow),
and the proper hepatic artery (single arrow).
FIGURE 13. Longitudinal view of the gallbladder
(GB) in the gallbladder fossa at the inferior aspect of
the main lobar fssure (arrow).
FIGURE 14. Figure 14A shows a longitudinal scan
plane demonstrating the common hepatic duct in
long asis, draping over the main portal vein (MPV)
and hepatic artery (arrow), seen in their transverse
planes. Figure 14B shos proper caliper placement for
the intrahepatic ductal measurement.
the right portal vein to the gallbladder (Figure 11).
1,3

Continuing to the inferior margin, the porta hepatis is
where the main portal vein, proper hepatic artery, and
common bile duct are located (Figure 12). Lateral to
that are the common hepatic duct (common duct); the
right, right posterior, and right anterior branches of the
portal vein; and, at the lateral margin, is the right hepatic
vein.
1,3,6
Return to the midline approach in a transverse
scan plane and sweep from the diaphragm through the
inferior margin of the left and caudate lobes, doing the
same for the right lobe from the intercostal or right lat-
eral approach. Because most of the liver is inside the rib
cage, imaging can sometimes present a challenge in get-
ting around or through the ribs. A left lateral decubitus
position, deep inspiration, or even full expiration while
distending the belly can possibly move the liver into a
more approachable position.
3
The gallbladder lies positioned against the inferior liver
edge, posteriorly, within the gallbladder fossa, which is
located in the inferior portion of the main lobar fissure
(Figure 13).
1,3,6
Longitudinal and transverse images can
14A
14B
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be obtained either from an intercostal or subcostal window
to look for stones, polyps, sludge, folds, wall thickening,
air, or pericholecystic f luid. Deep inspiration can often
move the gallbladder out from under the costal margin.
The gallbladder is quite frequently anterior enough to be
well seen with a higher frequency transducer, allowing
for improved resolution.
4,5
Left lateral decubitus images should also be obtained,
regardless of whether there were any findings on the
other images. In this decubitus position, when the gall-
bladder falls into a different location, the imaging can
potentially reveal findings not visible in a supine view.
3

Using the upright position is often overlooked as another
option for better gallbladder visualization or for confir-
mation of pathologic findings, such as mobility of a stone
lodged in the gallbladder neck or a stone vs polyp deter-
mination. A measurement of the common hepatic duct
is standard in evaluating the biliary tree. Measurement
for the common hepatic duct is obtained where the duct
drapes over the main portal vein and proper hepatic
artery (Figure 14A).
1
Here, the cystic duct joins the
common hepatic duct to form the common bile duct,
which exits the liver parenchyma medially. The measure-
ment is taken at this location to assure an intrahepatic
measurement (Figure 14B).
1
Because the caliber of the
extrahepatic portion has a larger allowance, if the mea-
surement is taken extrahepatically and incorrectly labeled
as the common hepatic duct, the reported number inac-
curately reflects biliary dilatation (Figures 15A and 15B).
A normal value for the common hepatic duct measure-
ment should equate to about 1 mm per ten years of age:
for example, 3 mm for a 30-year-old patient.
3
The duct
can measure larger in a postcholecystectomy patient.
3

Extrahepatically, now called the common bile duct, it
can be found anterior to the main portal vein coursing
towards the inferior margin of the pancreatic head, where
it forms a common trunk with the pancreatic duct at the
ampulla of Vater in the duodenum.
1
The pancreas lies transverse midline, the head resting
directly anterior to the inferior vena cava, the body
directly anterior to the conf luence of the splenic and
portal veins (Figure 16). Deeper, you can see the superior
mesenteric artery and aorta in their transverse axis, and
finally the tail between the spleen and upper pole of the
left kidney.
1,3,6
The pancreatic duct, also seen running in a trans-
verse plane from tail to head, should measure approxi-
mately 2 mm or less.
3
The gastric antrum and a portion
of the duodenum lie anterior to the area encompassing
the pancreas and extrahepatic bile duct and make the
section difficult to image in most cases, because even
after fasting the antrum and duodenum are typically gas
filled, creating an acoustic shadow blocking all or most of
the target anatomy (Figure 17A).
3-5
Change of patient
position, deep inspiration, or ingestion of water can be
helpful in this situation (Figures 17B and 17C).
3
When
choosing to use ingestion of water to displace gastric
FIGURE 15. Figure 15A shows an incorrect scan
plane and caliper placement for the common hepatic
duct measurement, or the intrahepatic portion. Tis
image is actually the common bile duct, or the extra-
hepatic portion. Figure 15B shows the same patient,
with corrected scan plane and caliper placement,
which now demonstrates the appropriate image with
correlating measurement.
FIGURE 16. Transverse scan plane depicting the
pancreas in its long axis, posterior to the left hepatic
lobe and gastric antrum, anterior to the splenic-
portal vein confuence.
15A
15B
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FIGURE 17. Figure 17A depicts the gastric
antrum (arrow), distended with air, obscuring vi-
sualization of the pancreas. Figure 17B is an image
of the same patient after ingestion of water. Te
liquid begins to displace some of the contents within
the stomach (STO) and the pancreas, which is di-
rectly posterior to it, becomes partially visible. Te
water within the stomach lumen (STO) continues
to creaste an acoustic window, and a diagnostic
image of the pancreas is obtained, utilizing the
water path as seen in Figure 17C.
FIGURE 18. Figure 18A shows a longitudinal
image of the spleen (arrow) in the left upper quad-
rant. Figure 18B shows another view of the spleen,
with the pancreatic tail (arrow) visualized between
the spleen and the upper pole of the left kidney (LK).
air and act as an acoustic window, the use of a drinking
straw is effective to reduce the amount of air swallowed
with the water.
The spleen is in the left upper quadrant under the left
hemidiaphragm and is bordered medially by the left lobe
of the liver and the stomach and inferiorly by the pancre-
atic tail and left kidney (Figures 18A and 18B).
1,3
Place
the patient in a right lateral decubitus position and scan
in a longitudinal and transverse oblique plane between
the ribs, evaluating splenic size and texture.
The kidneys are retroperitoneal and lie posteriorly on
the lower portion of the quadratus lumborum muscle,
roughly between the 12th thoracic and 3rd lumbar ver-
tebral bodiesusually with the left kidney 1 cm to 2 cm
higher than the right.
1,3,6
They are bordered medi-
ally by the psoas muscle and laterally by the transverse
abdominus muscle.
1,3,6
To evaluate renal length and
parenchymal integrity and check for masses, calculi, and
calyceal, pelvic, or ureteral dilatation in the right kidney,
scan from an anterolateral or coronal position with the
patient supine. Use the liver for a window as much as
possible (Figure 19A). If bowel obscures the lower pole,
roll the patient into a left lateral decubitus position or
have the patient take a deep breath to move the liver,
17A
17B
17C
18A
18B
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FIGURE 19. Figure 19A is a longitudinal image
of the right kidney (arrow), using the right hepatic
lobe as an acoustic window. A transverse view of the
right kidney (arrow) in the same patient is shown in
Figure 19B.
adrenal glands are not typically seen in the average adult
patient, but knowing their approximate location is impor-
tant because it may be necessary to differentiate upper pole
renal from adrenal pathology.
3
The right adrenal gland
lies between the upper pole of the right kidney, the pos-
terior surface of the liver, and the inferior vena cava.
1,3,6
The left adrenal gland rests on the upper pole of the left
kidney, bordered anteromedially by the spleen.
1,3,6
CONCLUSION
This brief guide has provided a basic understanding
on where and how to get started with general abdom-
inal ultrasound imaging. Certainly, much more may be
learned in regards to sonographic physics and instru-
mentation, pathologic evaluation, and visceral vascular
studies, all of which should build on the base of these
general guidelines and techniques.
which may help displace the bowel or move the kidney
into a better acoustic window.
3
Typically, the same scan
window and technique can be used for the transverse
images (Figure 19B).
The left kidney is often more difficult to image because
the spleen does not afford much of a scan window and
the majority of the remaining left upper quadrant struc-
tures are bowel (Figure 20A).
1,3,6
Scanning coronally
or more posteriorly, rolling the patient into a right lateral
decubitus position with a deep suspended inspiration is
often the only technique available to get around the bowel
gas.
3
Scanning from a posterior approach (often as a last
resort) may provide diagnostic information, although the
images may not be aesthetically pleasing. However, in
some instances this approach can yield quality images,
ending in a truly diagnostic study (Figure 20B).
Depending on the protocol set up by the lab, you may
also need to include longitudinal and transverse images
of the urinary bladder to complete the renal study. The
FIGURE 20. Figure 20A is a longitudinal, anterior
intercostal view of the left kidney. Te spleen (SPL)
afords an acoustic window sufcient for viewing
only the upper and mid portions of the kidney. Te
result is nonvisualization of the lower pole (LP) area
from this scan plane. Figure 20B shows a coronal
or more posterior approach in the same patient, and
the left kidney, specifcally the lower pole (arrow) is
better visualized.
19A
19B
20A
20B
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REFERENCES
Rumack CM, Wilson SR, Charboneau JW, eds. Diagnostic
Ultrasound Vol 1. 2nd ed. St. Louis, Mo: Mosby-Year Book; 1998.
Tortora GJ. Principles of Anatomy and Physiology. 6th ed. New
York, NY: Harper and Row; 1990:758-9.
Sanders RC Miner NS, eds. Clinical Sonography: A Practical
Guide. 2nd ed. Boston, Mass: Little, Brown and Co; 1991.
Hykes DL. Ultrasound Physics and Instrumentation. 2nd ed. St.
Louis, Mo: Mosby-Year Book; 1992.
Bushong SC. Diagnostic Ultrasound: Physics, Biology, and
Instrumentation. St. Louis, Mo: Mosby-Year Book; 1991.
Mittelstaedt CA. Abdominal Ultrasound. New York, NY:
Churchill Livingstone; 1987.
1.
2.
3.
4.
5.
6.
BASIC ABDOMINAL SONOGRAPHY
POST TEST
Expires: June 15, 2011 Approved for 1 ARRT Category A Credit.
1. The patient preparation for abdominal ultrasound
typically consists of fasting _______ hours prior
to the exam
12
35
68
1012
2. Examinations evaluating only the kidneys or
spleen
require the patient take a laxative the day before.
require the patient to fast for a certain number
of hours.
require the patient to have only clear fluids for
12 hours.
do not require a fasting preparation.
3. Which of the following is a consequence of setting
the depth too far past the organ of interest?
The visual resolution of the organ of interest is
decreased.
The frame rate is noticeably decreased.
The target anatomy takes up the majority of the
field of view and reveals echoes from just a few
centimeters beyond the area of interest.
Image distortion can mimic a condition such as
cholecystitis or portal hypertension.
4. Which of the following is a possible consequence
of setting the gain too high?
Echoes can be added to cystic structures,
making them appear complex or solid.
Echoes are removed from a complex structure,
resulting in a simple appearance.
Soft tissue information is lost.
Streak artifact degrades the image.
5. Increasing the dynamic range effectively
limits the returning echo.
increases the number of shades of gray
displayed.
decreases the image sensitivity.
increases the size of the image displayed.
6. Transducer selection is dependent on
patient preparation.
patient age and mobility.
patient body habitus and the exam to be
performed.
the sonographer's preference.
7. What is the tradeoff for using a transducer with
higher frequency?
Decreased sensitivity to smaller structures
Decreased resolution
Masked or mimicked pathology
Loss in depth of penetration
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
BASIC ABDOMINAL SONOGRAPHY: A PROCEDURAL OVERVIEW
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8. By design, linear transducers are better
for superficial imaging.
when a large field of view is essential.
for imaging deeper structures.
when the patient is obese.
9. 7 MHz transducers are most commonly used for
deep structures.
large patients.
pediatric patients.
average adult patients.
10. To begin scanning the liver, you should place the
transducer
at the level of the umbilicus.
toward the left, at the level of the iliac crest.
approximately four inches to the right of the
umbilicus.
in the midline epigastric region.
11. The ligamentum teres and umbilical vein divide the
lateral and medial segments of the left lobe of
the liver.
posterior left lobe and the caudate lobe of the liver.
body and tail of the pancreas.
right lobe of the liver into three segments.
12. Compared to the portal vein, hepatic veins
are located more inferiorly and have clearly
defined borders.
are located more superiorly and have poorly
defined borders.
branch away from the porta hepatic in the
right lobe.
have echogenic collagenous walls.
13. In most situations, the best way to evaluate the
right lobe of the liver longitudinally is
a midline approach.
an intercostal and right lateral approach.
by placing the patient in a right lateral decu-
bitus position and using the spleen as an
acoustic window.
by placing the patient in a prone position.
14. The gallbladder fossa is located
in the back part of the longitudinal fissure and
is situated mainly on the posterior surface of
the liver.
between the posterior surface of the liver and
the diaphragm.
in the inferior portion of the main lobar fissure.
between the quadrate lobe and the left lobe of
the liver.
15. In addition to images taken with the patient
supine, left lateral decubitus images of the gall-
bladder should be obtained because
the position of the gallbladder can change,
potentially revealing findings not seen on the
supine view.
this is the only way that the common bile duct
can be visualized.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
this procedure moves the gallbladder out from
under the ribs.
this is the only position that allows use of a
higher frequency transducer.
16. Which of the following is considered a normal
measurement for the common hepatic duct of a
50-year-old patient?
2 mm
5 mm
7 mm
9 mm
17. Which is a normal measurement for the pancreatic
duct?
2 mm
23 mm
34 mm
6 mm
18. Which of the following techniques is NOT rec-
ommended to better visualize the pancreas and
extrahepatic bile duct?
Change the position of the patient.
Have the patient take in a deep breath.
Have the patient drink water through a straw.
Have the patient drink a carbonated sugar-free
beverage.
19. What position is best for evaluating the spleen?
Prone
Supine
Left lateral decubitus
Right lateral decubitus
20. The kidneys are bordered medially by the
transverse abdominus muscle.
hepatic flexure or the splenic flexure of the
colon.
psoas muscle.
teres major muscle.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
a.
b.
c.
d.
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Article Title: Basic Abdominal Sonography: A Procedural Overview