The practice guideline for the standard obstetrical ultra­sound examination identifies the four-chamber, left ventricular outflow tract (LVOT), and right ventricular outflow tract (RVOT) views as the minimum components in evaluation of the heart. Additional views are incorporated during dedicated fetal echocardiography and when an abnormality is sus­pected. Video clips are useful in documenting cardiac findings, facilitating assessment of cardiac motion. Doppler analysis is beneficial in detecting…

Central nervous system (CNS) abnormalities are among the most common congenital anomalies. A systematic evaluation of the head and spine should be performed to include, at a minimum, the following structures listed in the practice guideline for the standard obstetrical ultrasound examination: the lateral cerebral ventricles, the choroid plexus, the midline falx, the cavum septi pellucidi, the cerebellum, the cisterna magna, the upper lip, and the…

Ultrasound is the most widely used imaging test in early pregnancy. Confirmation of a live intrauterine pregnancy requires sonographic identification of an intrauterine gestational sac with an embryo exhibiting cardiac activity. Other disorders such as failed intrauterine pregnancy, ectopic pregnancy, gestational trophoblastic disease, pelvic inflammatory disease, and endometriosis may complicate the ultrasound examination. The ultrasound examination is best interpreted in conjunction with the result of a…

The sonographic evaluation of the fetus includes assessments that extend beyond simple evaluation of fetal anatomy. Fetal well-being can be evaluated using surveillance methods such as fetal size and growth, Doppler waveform analysis, and the biophysical profile (BPP). In combination with the clinical findings, these tests help predict when fetuses are compromised and facilitate management decisions such as the timing of delivery. Amniotic Fluid Volume General…

Practice Guidelines: Overview This chapter reviews the components of the standard obstetrical (OB) ultrasound examination, as delineated in the ACR-ACOG-AIUM-SRU Practice Parameter for the Performance of Obstetrical Ultrasound. The practice parameter was developed through the collaboration of the American College of Radiology (ACR), American College of Obstetrics and Gynecology (ACOG), American Institute of Ultrasound in Medicine (AIUM), and the Society of Radiologists in Ultrasound (SRU). The…

Tendons A number of superficial structures in the extremities are well suited for sonographic imaging. This is especially true of tendons. The interfaces between internal tendon fibers produce strong specular reflections when the sound reflects off the tendon at 90 degrees. The result is referred to as a fibrillar pattern and consists of closely spaced, parallel, bright linear reflections ( Fig. 11-1 ). When imaged at…

Thyroid Normal Anatomy The normal thyroid gland is located in the anterior inferior neck. It is divided into two lobes resting on either side of the trachea. The lobes are connected at their lower third by a thin isthmus that crosses anterior to the trachea ( Fig. 10-1 ). Immediately anterior to the thyroid are the thin strap muscles (sternohyoid, sternothyroid, and omohyoid). Lateral to the…

Bowel Sonography is not routinely used as a primary tool for evaluation of the bowel. Nevertheless, there are many patients with nonspecific bowel-related complaints who are initially scanned with ultrasound, and in these patients attention to the intestinal structures can often identify the abnormality and direct the workup in the appropriate direction. Therefore a quick survey of the bowel is a useful undertaking in patients undergoing…

Anatomy The spleen is an intraperitoneal organ that occupies the superior, posterior, and lateral aspects of the left upper quadrant. It is normally in continuity with the diaphragm posteriorly, laterally, and superiorly. It contacts the kidney and splenic flexure inferiorly and the stomach and tail of the pancreas medially. The splenic artery arises from the celiac axis and travels along the posterior superior aspect of the…

Anatomy The pancreas is a retroperitoneal organ that develops from a large dorsal embryologic anlage and a smaller ventral anlage. The dorsal pancreatic anlage communicates by means of its central duct with the duodenum and the ventral anlage communicates with the biliary tract. During embryologic development these pancreatic anlagen rotate with the intestinal structures and ultimately fuse together so that the dorsal pancreas is located anterior…

Scrotum Sonography is the primary method used to image the scrotum. Patients undergoing sonography of the scrotum are usually examined in the supine position. A towel can be draped between the thighs to help support the scrotum. Warm gel should always be used because cold gel can elicit a cremasteric response and make it very difficult to perform a thorough examination. The anatomy relevant to the…

Anatomy Unlike the other solid abdominal organs, the kidneys have a complex internal architecture that is responsible for pro­ducing a variety of internal echogenicities. The central renal sinus is composed of fibrofatty tissue that appears echogenic on sonograms. The renal vessels and collecting system are occasionally seen as thin, anechoic, fluid-containing structures located within the echogenic tissues of the renal sinus. The lymphatics also pass through…

Anatomy The bile ducts are generally divided into the intrahepatic and extrahepatic portions. The intrahepatic ducts run in the portal triads with the portal veins and hepatic arteries. The right and left hepatic ducts are anterior to the adjacent portal veins. The peripheral intrahepatic ducts run parallel and adjacent to the hepatic arteries and portal veins, but the relative anterior and posterior relationship of the three…

Anatomy The liver is the largest solid organ in the normal abdomen, occupying much of the right upper quadrant. The liver is divided into eight functional segments based on vascular and biliary anatomy. The middle hepatic vein marks the division between the right and left hemiliver. The right hepatic vein divides the right hemiliver into an anterior and posterior section. The left hepatic vein divides the…

Anatomy The gallbladder is a long oval-shaped organ that is positioned beneath the liver immediately adjacent to the interlobar fissure ( Fig. 2-1 ). The fissure can be a useful landmark for locating small contracted gallbladders or gallbladders that are completely filled with stones. Likewise, the gallbladder can be used as a landmark for identifying the junction between the left and right hemiliver. The upper limit…

Ultrasonography has long been a valuable method of imaging the body with several distinct advantages over other modalities. One of the most important advantages is its lack of ionizing radiation. Sonography can provide clinically useful information without clinically significant biologic effects on the patient. This is critical in obstetrics, very important in the pediatric patient population, and becoming increasingly important in adults due to radiation dose…