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The Parathyroid Glands

Summary of Key Points In the vast majority of cases, primary hyperparathyroidism is caused by hyperfunction of a single parathyroid gland due to adenoma, much less commonly due to multiple gland involvement. Surgical removal of the abnormal gland is the only definitive treatment for primary hyperparathyroidism, and selective, minimally invasive surgical techniques are most commonly used for first-time surgery. The role of parathyroid imaging is not…

The Thyroid Gland

Summary of Key Points Ultrasound is the best imaging modality to study the thyroid gland for both diffuse and nodular disease. The overwhelming majority of thyroid nodules are benign. Thyroid cancer is rare and accounts for less than 1% of all malignant neoplasms. Approximately 80% of nodular thyroid disease is caused by hyperplasia. When hyperplasia leads to an overall increase in size or volume of the…

Organ Transplantation

Summary of Key Points To perform an ultrasound assessment of a transplanted organ, the sonographer should be aware of the surgical technique used including the type and location of vascular and nonvascular anastomoses. Gray-scale parenchymal changes often reflect the vascular status of the allograft (e.g., echogenic intraluminal material within a dilated biliary tree of a transplanted liver may result from sloughing of the biliary epithelium as…

Ultrasound-Guided Biopsy of Chest, Abdomen, and Pelvis

Summary of Key Points Ultrasound is a key method of guidance for biopsy and fluid drainage because of its real-time needle visualization and the ability to image and intervene in multiple anatomic locations and planes. Effective periprocedural antithrombotic management requires an understanding of specific antithrombotic agents as well as the balance of the potential risk of hemorrhage from a given procedure versus the risk of a…

The Adnexa

Summary of Key Points The normal sonographic appearance of the ovaries changes with the menstrual cycle because of the influence of gonadotropins. These changes cease to occur as late menopause is reached and developing follicles are no longer present. Nonneoplastic lesions of the ovary and adnexa are usually simple cysts or cysts that contain blood products and are often physiologic. These include hemorrhagic physiologic cysts and…

The Uterus

Summary of Key Points Transvaginal ultrasound is usually needed for optimal assessment of the uterus. Uterine enlargement in a nonpregnant patient is most commonly caused by fibroids or adenomyosis. Adenomyosis should be considered when there is an enlarged globular shape of the uterus; heterogeneity or asymmetrical thickening of the myometrium; indistinct interface between the endometrium and myometrium; or cysts, echogenic striations, or echogenic nodules in the…

The Peritoneum

Summary of Key Points Ultrasound has a role in peritoneal imaging. Success is dependent on operator awareness and thorough technique. Inclusion of transvaginal scan in women will greatly improve accuracy. Ultrasound is excellent for detecting and characterizing peritoneal fluid. Ultrasound is very useful for detecting and characterizing neoplastic and inflammatory peritoneal disease. Ultrasound is often the modality of choice to guide paracentesis and biopsy of peritoneal…

Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall

Summary of Key Points Dynamic ultrasound is the key examination for assessing the groin or anterior abdominal wall pain. Dynamic components of the examination include Valsalva and compression maneuvers and scanning in both supine and upright positions. Dynamic sonography enables clinicians to determine hernia type, size, contents, reducibility, and tenderness. Evaluation of groin pain in athletes is frequently more complex than in nonathletes because of associated…

The Retroperitoneum

Summary of Key Points If an abdominal aortic aneurysm progresses to rupture, survival is very unlikely. If discovered before rupture, survival is highly likely. Most aneurysms are fusiform, which makes them readily diagnosable with ultrasound. Clinicians must also be aware of related entities that are more difficult to diagnose with ultrasound, including eccentric aneurysms, pseudoaneurysms, and penetrating ulcers. Ultrasound is not an appropriate method for the…

The Adrenal Glands

Summary Key Points The adrenal glands are responsible for maintaining homeostasis and regulating hormonal production and secretion within the body. The adrenal cortex is comprised of the zona glomerulosa, fasciculata, and reticularis, which are responsible for aldosterone, glucocorticoid, and androgen regulation, respectively. The adrenal medulla regulates catecholamines. Sonographic visualization of the right adrenal gland is best through a transverse oblique and coronal view, using the liver…

The Prostate and Transrectal Ultrasound

Summary of Key Points Prostate cancer is a significant health problem and its management is changing rapidly. Currently, transrectal ultrasound (TRUS) with biopsy is the primary modality to diagnose prostate cancer. New modalities including multiparametric magnetic resonance imaging and biomarkers are being introduced for prostate cancer assessment. Understanding of prostate cancer has evolved with recognition of aggressive and indolent forms, which are managed differently. Screening for…

The Kidney and Urinary Tract

Summary of Key Points Renal ultrasound is the screening modality of choice for the initial evaluation of renal insufficiency. Relevant imaging markers include parenchymal echogenicity, renal length, and collecting system dilatation. The primary role for ultrasound in the evaluation of renal masses is to differentiate between cystic and solid lesions, although an appropriate differential diagnosis may be given based on clinical history and cyst complexity. Echogenic…

The Gastrointestinal Tract

Summary of Key Points High-resolution ultrasound allows for excellent depiction of the bowel, including the normal multilayered appearance of the bowel wall and many pathologic features. Ultrasound is a safe, objective, and accurate method for measuring the severity of inflammatory activity in inflammatory bowel disease, an essential requirement considering the young population most often affected by this chronic and often debilitating disease. Contrast-enhanced ultrasound is an…

The Pancreas

Summary of Key Points Knowledge of a few key scanning techniques will optimize imaging of the entire pancreas. Understanding of the embryologic development, normal anatomy, and anatomic variants of the pancreas aids in detection and characterization of disease. Ultrasound plays an important role in assessment of acute and chronic pancreatitis, allowing for detection of gallstones, bile duct dilation, and guiding aspiration and drainage when needed. Computed…

The Biliary Tree and Gallbladder

Summary of Key Points Ultrasound should be the first imaging modality used in the evaluation of the patients with potential disease of the biliary tree. Awareness of various scanning techniques and use of harmonic and compound imaging improve visualization of various diseases affecting the biliary tree. Stones in the intrahepatic and extrahepatic biliary tree can be easily overlooked; familiarity with their appearance and a high index…

The Spleen

Summary of Key Points Ultrasound can be used to diagnose or exclude splenic abnormalities, but computed tomography and/or magnetic resonance imaging may be needed in indeterminate cases. There is no single upper limit of normal for spleen size, since size varies with patient sex, weight, and height. Use of a strict 12-cm upper limit of normal for the spleen will lead to overdiagnosis of splenomegaly. The…

The Liver

Summary of Key Points The liver is an ideal organ for sonographic evaluation based on its large size, homogeneous parenchyma, and location high in the abdomen with access provided from both a subcostal and an intercostal approach. Standard ultrasound with real-time gray-scale morphologic assessment and Doppler evaluation of the liver vasculature is augmented by newer techniques of contrast-enhanced ultrasound and elastography. Fatty liver is considered an…

Contrast Agents for Ultrasound

Summary of Key Points After more than 20 years of development and a somewhat hesitant start, microbubbles have finally come of age as a contrast agent for ultrasound. The principal requirements for an ultrasound contrast agent are that it should be easily introducible into the vascular system, be stable for the duration of the diagnostic examination, have low toxicity, and modify one or more acoustic properties…

Biologic Effects and Safety

Summary of Key Points Clinical ultrasound has been found to be an effective imaging modality with an excellent safety profile when used appropriately. Ultrasound can produce physical effects, which should be understood as part of the benefit-versus-risk assessment as with any medical procedure. The thermal index (TI) and mechanical index (MI) provide feedback to the user and should be minimized while obtaining the requisite medical benefit…

Physics of Ultrasound

Summary of Key Points Quality imaging requires an understanding of basic acoustic principles. Image interpretation requires recognition and understanding of common artifacts. Special modes of operation, including harmonic imaging, compounding, elastography, and Doppler, expand the capabilities of conventional gray-scale imaging. Knowledge of mechanical and thermal bioeffects of ultrasound is necessary for prudent use. High-intensity focused ultrasound has potential therapeutic applications. All diagnostic ultrasound applications are based…