Deciphering the ultrasound of the abdominal cavity. Ultrasound of the mammary glands

Abdominal ultrasound decoding is a series of numbers and characteristics of reflected ultrasound that you can see in the protocol of your own study.

In order to understand them at least a little before you go to the doctor, we suggest reading the following information.

What will the decoding of the ultrasound of the abdominal cavity show

First, let's see what this ultrasound shows.

Behind the front wall of the abdomen is a large space - the abdominal cavity. It contains quite a few organs, which will be shown by ultrasound of the abdominal cavity. This:

• stomach
• intestines
• pancreas
• liver
• bile ducts: intra- and extrahepatic
• spleen
• gallbladder
• kidneys
• adrenal glands
• abdominal aorta and its branches
• lymph nodes
• lymph trunks and vessels
• department of the autonomic nervous system
• nerve plexuses.

The abdominal cavity is lined with two layers of a thin membrane - the peritoneum. Its inflammation is called peritonitis and is a life-threatening condition. The organs are differently covered by the peritoneum: some are wrapped in it, some do not even touch, but are inside the boundaries outlined by it. Conventionally, the cavity is divided into the abdominal cavity proper and the retroperitoneal space. The latter is at the bottom of the list of organs, starting with the kidneys.

All these organs - both the abdominal cavity and the space behind the peritoneum - are looked at by an ultrasound examination of the abdominal cavity. This study is able to detect the presence of structural damage, inflammation, pathological formations, an increase or decrease in an organ, and a violation of its blood supply. Ultrasound does not see how a sick or healthy organ copes with its functional duties.

What does an ultrasound. The study helps to find the cause of the disease in such cases:

• pain or discomfort in the abdomen
• bitterness in the mouth
• feeling of a full stomach
• fatty food intolerance
• increased gas production
• frequent bouts of hiccups
• feeling of heaviness in the right or left hypochondrium
• jaundice
• high blood pressure
• lower back pain
• fever not due to a cold
• non-diet weight loss
• belly enlargement
• as a control over the effectiveness of the treatment of pathologies of the digestive system
• and also as a routine examination, including with existing anomalies in the development of organs, cholelithiasis.

Pathology determined by ultrasound

What does abdominal ultrasound diagnose? With the help of this study, the following diseases can be detected:

1. From the side of the gallbladder:

• acute and chronic cholecystitis
• bladder empyema
• gallstone pathology
• during a choleretic breakfast, it is possible to assess the motor function of the bladder
• developmental anomalies (kinks, partitions).

2. From the side of the liver:

• cirrhosis
• hepatitis
• abscesses
• tumors, including metastases
• hepatosis
• "Stagnation" in the liver due to cardiopulmonary diseases
• fatty change in the liver.

3. From the side of the kidneys and urinary system:

• kidney tumors
• "shrunken kidney"
• pyelonephritis
• narrowing of the ureters
• stones and "sand" in the kidneys.

4. From the side of the spleen, ultrasound of the abdominal cavity reveals:

5. From the side of the pancreas:

• cysts
• tumors
• abscesses
• stones in the channels
• signs of acute and chronic pancreatitis.

6. Ultrasound reveals free fluid in the abdomen

7. From the side of the abdominal part of the aorta or its branches, an aneurysm and its dissection, vasoconstriction can be seen

8. From the side of the retroperitoneal lymph nodes, their increase is visible, the uniformity of the structure

How to understand the results of the study

To do this, consider the form (protocol) of ultrasound. It indicates the points that relate to each organ separately.

Liver

Deciphering the ultrasound of the abdominal cavity in relation to this organ includes:

Share sizes:

Deciphering the results

1. Fatty hepatosis is evidenced by an increase in the echo density of the organ in the form of small foci. The edge of the liver is rounded. In the last stages, due to the compaction of the organ, it is impossible to see the portal vessels.
2. With cirrhosis of the liver, its increase, dilation of the portal and splenic veins is visible. The lower edge of the organ will also be rounded, the contours will be uneven. The increase in echo density in this case will be large-focal. Free fluid in the abdominal cavity (ascites) is also determined.
3. If an increase in size, rounding of the edges, as well as an expansion of the vena cava and the absence of narrowing it on inspiration, is described, this indicates congestion in the liver due to a heart or lung disease.
4. If foci are described in which there is a violation of the normal echostructure, this may indicate malignant or benign tumors, cysts or abscesses.

In the video, the specialist talks about the errors that occur during ultrasound examination of the abdominal organs.

gallbladder

The norm of ultrasound according to the results of the examination of this organ:

• Shape: various - pear-shaped, cylindrical.
• Dimensions: width 3-5 cm, length 6-10 cm.
• Volume: 30-70 cu. cm.
• Walls: up to 4 mm thick.
• Education in the lumen: in the norm they are absent.
• Acoustic shadow from formations: this applies to stones and bladder tumors. By the presence of this shadow, the types of stones are deciphered (they come in different compositions).
• Whether they move or not: the stones are usually mobile, but can be soldered to the wall or be large. According to this and some other signs, one can judge whether the formation is a tumor.

Signs of pathology of the gallbladder

1. In acute cholecystitis, there is a thickening of the wall of the organ, while the dimensions can be normal, reduced or enlarged. The wall can also be described as a "double circuit", and the presence of fluid around the bladder indicates that local peritonitis has already developed and an urgent operation is needed.
2. Thickening of the wall will be in chronic cholecystitis. The contour in this case is clear and dense.
3. In conclusion, various deformations of the organ can be described. This is not a disease, but a structural feature.
4. If echo-negative objects are described that leave an acoustic shadow, while the bladder wall is thickened and the contour is uneven, we are talking about calculous cholecystitis. At the same time, the expansion of the bile ducts indicates that the stone blocks the exit of bile.

Deciphering ultrasound of the bile ducts

Normally, on ultrasound, the bile ducts have the following characteristics:

• common bile duct: 6-8 mm in diameter
• intrahepatic ducts: should not be dilated

Norms of the pancreas on ultrasound

• There shouldn't be any extras.
• head: up to 35 mm
• body: up to 25 mm
• tail: about 30mm
• contour: smooth
• echostructure: homogeneous
• echogenicity: neither decreased nor increased
• Wirsung duct: 1.5-2 mm
• education: normally they are not.

A decrease in the echo density of the gland indicates acute pancreatitis, an increase in it indicates chronic pancreatitis or cancer. The expansion of the Wirsung duct also speaks of chronic inflammation. The "favor" of cancer is evidenced by a segmental increase in size and uneven contour of the gland, depression on the surface of the liver, as well as displacement or compression of the inferior vena cava or aorta.

Deciphering ultrasound of the spleen

• dimensions: length - up to 11 cm, thickness - up to 5 cm, longitudinal section - up to 40 square meters. cm
• splenic index: no more than 20 cm 2
• structure: normal - homogeneous
• splenic vein at the hilum.

1. You can see an increase in the size of the organ. It is associated both with certain blood diseases and with liver diseases (for example, cirrhosis) or infectious diseases.
2. Compacted (less often - less dense) tissue indicates a spleen infarction, that is, that as a result of thrombosis or injury, the death of some part of the organ occurred.
3. Ultrasound also allows you to see the rupture of the spleen, which usually occurs either with a strong injury, or with a minor bruise, but in the case of an enlarged organ.

Read also:

When should pregnant women go for an abdominal ultrasound?

Ultrasound of hollow organs (stomach, small, large and rectum)

It only indicates whether there is a symptom of an “affected organ” (it should not be) and whether there is fluid deposition in the intestinal lumen (this should also not be).

If ultrasound was also performed on the kidneys, then a description of this organ is also included in the conclusion of the study. The results of the examination of the kidneys by ultrasound are normal:

• width: 5-6cm
• length - about 11 cm
• organ thickness: 4-5cm
• kidney parenchyma - no more than 23 mm thick
• pelvis should not be dilated
• there should not be any structures in the lumen of the pelvis and ureters.

Lymphatic structures on ultrasound imaging

Ultrasound of retroperitoneal lymph nodes normally suggests such a conclusion "Lymph nodes are not visualized." That is, if they are of normal size, their ultrasound "does not see".

An increase in these organs of immunity indicates either an infectious disease present in the abdominal cavity, or a malignant formation. In the latter case, they can increase due to the fact that cancer cells of the hematopoietic system "live" in them, as well as with metastases of any adjacent organ tumor.

Sonologist's conclusions

In the conclusion of the ultrasound, the sonologist (ultrasound diagnostics doctor) indicates the presence of a pathology: he describes what the echo signs look like.

If the doctor indicates in the direction that it is necessary to conduct an examination for some disease, but his ultrasound did not visualize (for example, calculous cholecystitis), then the phrase “Echo signs of the disease were not detected” may be. The final diagnosis is made only by the doctor who directs the examination.

Who needs to undergo dopplerometry of the celiac vessels

This examination, which is also called UZDG (that is, Doppler ultrasound) of the celiac vessels, is often performed together with an ultrasound. The patient does not feel differentiated and is not more harmful than ultrasound. It allows you to evaluate the anatomy and characteristics of blood circulation in such vessels as:

• abdominal aorta
• common hepatic artery
• iliac arteries
• celiac trunk
• splenic artery
• superior mesenteric artery
• hepatic portal vein and its branches
• inferior vena cava.

Ultrasound of the abdominal vessels allows timely detection of early disorders in the vessels, identification and assessment of the degree of increase in pressure in the portal vein (with cirrhosis, “stagnant” liver), and assessment of the result of cava filter implantation.

Ultrasound of the abdominal aorta and its branches helps in the diagnosis of:

• fainting
• frequent headaches
• epileptic seizures
• high blood pressure
• repeated strokes (sometimes blood clots can “fly off” from this large vessel)
• pain in the legs
• potency disorders
• aortic aneurysms
• atherosclerotic lesion
• vasoconstriction
• anomalies in the development of large vessels.

duplex scanning

The study of blood vessels during ultrasound on modern equipment almost always includes duplex angioscanning. This is the "gold standard" in the assessment of blood circulation in the venous vessels.

It allows you to identify pathological blood reflux, obstruction of blood flow, to assess their localization, extent and severity.

With this type of study, the sonologist receives a two-dimensional color image of the celiac vessels, where red means the movement of blood to the sensor, and blue - on the contrary, from the sensor. According to the intensity of red and blue colors, the doctor draws conclusions about the speed of blood flow in any part of the vascular system.

To determine the anatomical and functional state of the fetus during pregnancy, there are a number of methods, the most common of which is. It is quite informative, allows you to reach a large number of women and, most importantly, is safe.

In order to detect malformations and diseases, ultrasonic(universal rapid survey, covering more than 85% of pregnant women). It allows you to make decisions about the further management of each pregnancy, as well as identify pregnant women at risk for the development of various complications for the fetus and mother.

Ultrasonography ( most appropriate to carry out in the following screening terms pregnancy:

Chorion- the outer villous embryonic membrane, which, together with the wall of the uterus, later forms, thanks to which the fetus is nourished during pregnancy. Its localization gives an idea of ​​the further localization of the placenta (what you need to know to determine the tactics of pregnancy management), and a change in thickness may indicate the presence of intrauterine infection of the embryo / fetus, as well as malnutrition of the fetus, although this indicator is also more informative in late pregnancy.

In addition, during the first, structural features of the uterus (for example, doubling of the uterus, saddle uterus) and its appendages (primarily the presence of ovarian cysts) are noted. These indicators are also important for determining further tactics of pregnancy management.

If necessary, the doctor of ultrasound diagnostics notes in the protocol the date of the repeated ultrasound control.

Deciphering the indicators of the second ultrasound at 20-24 weeks

Pregnancy 20-24 weeks optimal for studying the anatomical structures of the fetus. Identification at this time determines the further tactics of pregnancy management, and in case of a gross defect that is incompatible with life, it allows you to terminate the pregnancy. A typical ultrasound protocol at 20-24 weeks is presented in Table 5.

The structure of the ultrasound protocol can be divided into the following main groups:

1. Information about the patient (name, age, the beginning of the last menstruation)
2. Fetometry(measurement of the main dimensions of the fetus)
3. Anatomy of the fetus (organs and systems)
4. Provisional organs (temporarily existing, such as the placenta, umbilical cord, and amniotic fluid)
5. Conclusion and recommendations

In this protocol, as with ultrasound at 10-14 weeks, the first day of the last menstruation is indicated, relative to which the gestational age is calculated. It also notes the number of fruits and that the fruit is alive(this is determined by the presence of and ). In the presence of two or more fruits, each is studied and described separately. Be sure to indicate (the ratio of the large part of the fetus to the entrance to the pelvis). It may be head(fetus presented with head) and (buttocks and/or legs presented). The fruit may be located transversely which should be reflected in the protocol.

Next is carried out fetometry- measurement of the main dimensions of the fetus, among which are determined: the biparietal size of the head, its circumference and fronto-occipital size, abdominal circumference, the length of the tubular bones on the left and right (femur, humerus, bones of the lower leg and forearm). The combination of these parameters makes it possible to judge the rate of fetal growth and compliance with the estimated gestational age for menstruation.

Biparietal fetal head size (BDP) measured from the outer surface of the upper contour to the inner surface of the lower contour of the parietal bones (Figure 1, line bd).

Fronto-occipital size (LZR)– distance between the outer contours of the frontal and occipital bones (Figure 1, line ac).

Cephalic index- BPR / LZR * 100% - allows you to draw a conclusion about the shape of the fetal head.

Head circumference (OH)- the circumference along the outer contour.

Measurement of head dimensions is carried out with strictly transverse ultrasound scanning at the level of certain anatomical structures of the brain (cavity of the transparent septum, cerebral peduncles and visual tubercles), as shown in the right side of Figure 1.

Figure 1 - Scheme for measuring the size of the fetal head

1 - cavity of the transparent septum, 2 - visual tubercles and legs of the brain,bd- biparietal size,ac- fronto-occipital size

The dimensions of the abdomen are measured by scanning in a plane perpendicular to the spinal column. This defines two sizes - diameter and circumference of the abdomen, measured along the outer contour. The second parameter is used more often in practice.

Further measured length of the tubular bones of the limbs: femoral, shoulder, lower leg and forearm. It is also necessary to study their structure to rule out the diagnosis. skeletal dysplasia(genetically determined pathology of bone and cartilage tissue, leading to serious disorders in the growth and maturation of the skeleton and affecting the functioning of internal organs). The study of the bones of the limbs is carried out on both sides, so as not to miss reductional malformations(that is, underdevelopment or absence of parts of the limbs on one or both sides). Percentile values ​​of fetometric indicators are shown in Table 6.

Studying fetal anatomy- one of the most important components of ultrasound at 20-24 weeks. It is in this period manifest(manifest themselves) many. The study of the anatomical structures of the fetus is carried out in the following order: head, face, spine, lungs, heart, abdominal organs, kidneys and bladder, limbs.

Studying brain structures begins even when measuring the size of the head, because upon careful examination, the doctor can determine the integrity of the bone structure, the presence extracranial(outside the skull) and intracranial(intracranial) formations. The study of the cerebral hemispheres, the lateral ventricles, the cerebellum, the large cisterna, visual tubercles and the cavity of the transparent septum is carried out. The width of the lateral ventricles and the anteroposterior size of the large cistern do not normally exceed 10 mm. An increase in this indicator indicates a violation of the outflow or production of fluid and the appearance of dropsy of the brain.

The next step is studying face– the profile, eye sockets, nasolabial triangle are assessed, which makes it possible to identify anatomical defects (for example, “protrusion” of the upper jaw in case of bilateral or median facial cleft), as well as the presence of markers of chromosomal abnormalities (reduction of the length of the nasal bones, smoothed profile). When studying the eye sockets, a number of gross defects can be determined, for example, cyclopia(eyeballs are completely or partially fused and are located in the middle of the face in one eye socket), neoplasms, anophthalmia(underdevelopment of the eyeball). The study of the nasolabial triangle primarily reveals the presence of the palate.

Study spine throughout in longitudinal and transverse scanning - allows you to identify hernial protrusions, including spinabifida- spina bifida, often combined with malformations of the spinal cord.

When researching lungs their structure is studied (the presence of cystic formations can be determined), sizes, the presence of free fluid in the pleural (thoracic) cavity, neoplasms.

Further study heart for the presence of four chambers (normally, the heart consists of 2 atria and 2 ventricles), the integrity of the interventricular and interatrial septa, valves between the ventricles and the atria, as well as the presence and correct discharge / confluence of large vessels (aorta, pulmonary trunk, superior vena cava) . The very location of the heart, its size, changes in the heart bag (pericardium) are also evaluated.

When scanning organs abdominal cavity- stomach and intestines - their presence, location, size is determined, which makes it possible to indirectly judge other organs of the abdominal cavity. In addition, an increase or decrease in the size of the abdomen during fetometry indicates the presence of a pathology (for example, dropsy, hernia, hepato- and splenomegaly - an increase in the liver and spleen). Further research kidneys and bladder for their presence, shape, size, localization, structure.

Studying provisional authorities allows you to indirectly judge the condition of the fetus, intrauterine infections and other conditions that require correction.

It is studied according to the following parameters:

1. Localization. The doctor of ultrasound diagnostics necessarily reflects the localization of the placenta, especially its position relative to the internal pharynx of the cervix. Since with improper attachment of the placenta, for example, when it completely covers the internal os ( complete), this is accompanied by bleeding during pregnancy, and vaginal delivery is not possible. If the lower edge of the placenta is located lower than 7 cm from the internal os, ultrasound control is required at 27-28 weeks.
2. Thickness. The placenta is a dynamically developing provisional organ of the fetus, therefore, during pregnancy, its thickness increases on average from 10 to 36 mm, although these values ​​vary in a fairly large range, which is presented in table 7.

After 36 weeks, the thickness of the placenta usually decreases. The discrepancy between this parameter and the normative values ​​should alert, first of all, regarding the presence of an intrauterine infectious process, as well as the discrepancy between the nutrients supplied to the fetus and its needs.

1. Structure. Normally, it is homogeneous, it should not have inclusions. Inclusions may indicate premature aging of the placenta (which can cause fetal growth retardation), heterogeneity indicates the possible presence of infection.
2. The degree (stage) of maturity. The placenta changes its structure unevenly, most often this process occurs from the periphery to the center. In an uncomplicated course of pregnancy, changes go through stages from 0 to III sequentially (0 - up to 30 weeks, I - 27-36, II - 34-39, III - after 36 weeks). This indicator allows predicting the complicated course of pregnancy, the presence of syndrome (SZRP). Currently, the presence of II degree up to 32 and III degree up to 36 weeks is considered to be premature maturation of the placenta. An ultrasound assessment of the structure of the placenta is shown in Table 8.

* chorionic membrane - layer with villi facing the fetus

** parenchyma- tissue of the placenta

*** basal layer- the outer surface that the placenta adjoins the wall of the uterus

Used for evaluation amniotic fluid index. When it is determined, the uterine cavity is conditionally divided into 4 quadrants by two planes drawn through the white line of the abdomen (the connective tissue structure of the anterior abdominal wall located along the midline) vertically and horizontally at the level of the navel. Further, in each quadrant, the depth (vertical size) of the largest pocket of amniotic fluid (amniotic fluid) free from parts of the fetus is determined, all 4 values ​​are summed up and displayed in centimeters. If the index is less than 2 cm - this is, if more than 8 cm -. This is a diagnostically significant sign of the presence of infection, malformations. Indicators of the amniotic fluid index at different stages of pregnancy are presented in Table 9.

Umbilical cord(a provisional organ that connects the embryo / fetus with the mother's body) normally contains 3 large vessels: one vein and two arteries. In many hereditary pathologies, only one umbilical artery occurs, which requires more careful management of pregnancy.

Also subject to mandatory research (for its length, which is important in the presence of a threat of termination of pregnancy), appendages(for ovarian cysts) uterine wall(if there was a caesarean section in the anamnesis, the condition of the scar is assessed).

Based on the ultrasound examination performed during pregnancy, a conclusion is made about the presence of (VLOOKUP) fetus or some other pathology and recommendations are given.

Ultrasound indicators in the third trimester

Third ultrasound at 32-34 weeks necessary to detect malformations that appear only in late pregnancy (for example, , aneurysm of the vein of Galen- violation of the structure of the vascular wall of a large cerebral vessel). It allows you to assess the functional state of the fetus, make a diagnosis syndrome (SZRP), which makes it possible to carry out a complex of necessary therapeutic measures, to identify indications for timely and careful delivery. The presence of sdfd requires mandatory monitoring after 7-10 days against the background of active therapy.

An important point is (head or), which significantly affects the method of delivery. It is also necessary to define estimated fetal weight, which should be taken into account in the tactics of further management of pregnancy and especially childbirth.

To assess the condition of the fetus in the third trimester, the definition can be used biophysical profile of the fetus during ultrasound (Table 10).

When evaluating the tabular parameters, the sum of the points is determined, on the basis of which a conclusion is made about the condition of the fetus:

• 12-8 – norm;
• 7-6 - the doubtful condition of the fetus, the possible development of complications;
• less than 5- pronounced intrauterine hypoxia(lack of oxygen supply to the fetus, leading to varying degrees of impairment of its vital functions) with a high risk perinatal losses(fetal loss between pregnancy and 168 hours after birth).

Ultrasound examination during screening periods allows to detect a large number of pathologies and take preventive measures to eliminate them as much as possible in the prenatal period, and if it is impossible to eliminate them, to reduce the consequences.

To date, there are no uniform standards that define the means of documentation.

Video printers are the most commonly used. Their purchase is economically justified. Often such printers are supplied with an ultrasound machine. Video printer paper is also inexpensive, and the new generation and modern grades of paper make it possible to obtain an ultrasound image of very high quality and contrast. Other advantages of images produced by video printers are their small size (so they can be easily attached to a patient's medical records) and the possibility of archiving. The disadvantages of such images are their dullness and the impossibility of displaying them on the screen during medical conferences, and therefore they have to be passed from hand to hand.

X-rays have the following advantages:

durability;

the possibility of projecting them on the screen;

greater contrast and brightness of the echogram than images obtained using video printers and polaroids.

Exposure is carried out by a multi-format camera or a laser imager. Documenting imaging results with radiographs is less expensive than using a video printer, but radiographs are difficult to store in the medical history and must be kept separately. This method of documentation, as a rule, is used in X-ray departments or departments of radiation diagnostics, which, along with ultrasound machines, also have a computer and / or magnetic resonance tomograph, fluoroscopic and other devices and a special archive for storing radiographs.

Currently, digital image archives are widely used, which provide storage of a complete set of patient data. Such archives are supplied to the medical equipment market by several manufacturers and are attached to ultrasound machines or sold separately or as part of software and are relatively inexpensive. An important solution to the problem of documenting data in the clinic is the so-called Picture Archiving and Communication System (PACS), which stores complete digital information about all the results of imaging diagnostics without exception (ultrasound, CT, MRI, digital subtraction angiography, etc.). .), brought into line with the requirements of international standards (DICOM) in the format developed by the manufacturer. Ideally, PACS should be synchronized with Radiology Information System (RIS) and Hospital Information System (HIS), which will have patient biographical data, written descriptions, performance requirements, and coordinate and data accounting. Such systems require professional maintenance by numerous personnel.

A thorough examination of the patient is more important than documenting the results of the ultrasound image analysis, because if you do not carefully examine the patient and then perform a targeted ultrasound, then you may not see the lesion or the desired anatomical formation on the obtained ultrasound image. The purpose of obtaining an image is to make the condition of a healthy or diseased organ more understandable to an independent observer and to provide him with an arbitrary fragment of the entire organ. Sonograms should also be representative.

Make sure that the place where you found a suspicious formation on the ultrasound image (the so-called acoustic site of the disease - “Morbus Schall”) corresponds to the anatomical structure or organ. The discrepancy indicates the pathological nature of the formation, which is most often detected in those areas of the echogram that are not given enough attention.

Signs of a good ultrasound image:

Compliance with the technical requirements for the study (optimal adjustment of the technical parameters of the ultrasound machine and selection of a suitable ultrasound sensor). Compliance with this requirement is fundamentally important, although it seems trivial. The liver should correspond in brightness to a gray color of moderate intensity, the vessels should be anechoic. The quality of the image, of course, depends on the characteristics of the constitution of the patient.

Documenting the position of the ultrasonic sensor. In most ultrasound devices, the image has an icon on which you can indicate the location of the sensor, otherwise it can be difficult to understand marks like “transducer position transverse to the left”.

Absence of "Morbus Schall"

Image of anatomical structures used as landmarks (for example, aorta, inferior vena cava, portal vein, hepatic veins, diaphragm), so that an experienced specialist, without instructions about the location of the transducer, can easily understand how the ultrasound slice passes and where the detected on the echogram is located education. Train yourself to perform ultrasound with strictly defined transducer positions.

Marking and description of relevant structures in the case when, due to the conditions of the ultrasound, the topographic-anatomical relationships on the echogram remain unclear.

Each pathological formation must be visualized and measured on echograms obtained in two projections. However, in a complex study, for example, when the liver is diffusely affected by metastases, this principle has to be sacrificed. In this case, it is necessary to confine oneself to a qualitative cut or the most modified area. In cancer research, usually at the first ultrasound, an “indicative metastasis” or some kind of lesion that is observed during the entire period of treatment instead of the whole organ is selected.

The results of ultrasound of any organ are subject to documentation. It is more economical when, during the study, all adjacent organs on the ultrasound image fall into one slice. The classic is a transverse section through the caudal part of the right lobe of the liver, gallbladder, right kidney, although from an anatomical point of view there are no bad sections!

The following images show the trade-off between the completeness of the study and its costs. However, these factors, as well as the physique of the patient, are not a strong argument for always obtaining images of the same sections on echograms. It is often necessary to limit the amount of documentation for reasons of time saving.

The amount of storage media is constantly growing. Even today, modern PACS make it possible to obtain thousands of images from one CT scan; such are the possibilities of functional MRI. Only with ultrasound one has to be content - at least with native echography - with individual images in the amount of 1 to 20.

Why not draw up a clear protocol and, in accordance with it, pan the entire organ or part of it (an experienced specialist does this) and store all the information received in real time in the memory of the device? This will allow you to fully capture not only the examined volume, but also echograms with images that the specialist considered the most informative. Such films are already available on commercially available ultrasound machines and make it possible to retrospectively judge whether the changes detected at the moment were already during previous ultrasounds. Not all ultrasound machines are designed to store such films, but this possibility is available in all new ultrasound machines, and it first appeared to store a sequence of images obtained with contrast ultrasound. Some shortcomings of ultrasound, in particular the lack of standardized ultrasound sections and the dependence of the quality of the study on the experience and skill of a specialist, cannot be completely eliminated. However, the actions taken in this direction are an important step towards a more complete fixation of the results of the study. A significant rethinking of this problem is needed, but it is difficult to imagine how it will be solved in the future.

Description of ultrasound results

The description of the results of ultrasound is a compromise between the desire for a more complete study, the readability of the results and the brevity of the presentation of information. Only clinically significant changes and findings should be described. A good example is the position of the kidneys. Since it can be abnormal and indicate a pathological process, it is reasonable and logical to note in the description of the results that “the kidneys are located correctly”. On the other hand, it is unnecessary to indicate in the description that "the liver is in an orthotopic position" (if there is no liver dystrophy). Since the kink of the gallbladder at the border between the bottom and the body (deformity in the form of a "Phrygian cap") has no clinical significance, this change is inappropriate to describe.

The results should be described by US-morphological concepts. The wording "adenomatous thyroid nodule with regressive changes" cannot be presented in the description of the results, except when evaluating them, although here this wording is inappropriate, since it is already contained in the histological report. It would be more correct to formulate it as follows: "a volumetric formation with a diameter of 2 cm with a hypoechoic marginal and anechoic central zone with a diameter of 1 cm with the phenomenon of distal pseudo amplification and amplification of the echo signal from the back wall."

Several single formations are described separately, while diffuse ones, on the contrary, are described in summary. A large multinodular goiter, for example, can be described as follows: "In both lobes of the thyroid gland there are multiple echogenic volumetric formations of the same density with a diameter of 1-4 cm with a hypoechoic marginal and anechoic central zone." There is no generally accepted rule for describing a normal or pathological ultrasound picture, so you can always find fault with the existing formulations. Next, we give a well-established form for describing a normal ultrasound picture:

Liver of normal size, with smooth contours, normal homogeneous echostructure, without focal changes. Intra- and extrahepatic bile ducts and vessels are not changed.

The gallbladder is of normal size, with a thin wall, without echogenic formations in the lumen.

Both kidneys are of normal shape, size and position, respiratory excursion is within the normal range, IPS is normal. There are no signs of stagnation, shadows of calculi and volumetric formations.

The pancreas is visible throughout from the head to the tail, has a normal size, no calculi and space-occupying formations. The pancreatic duct is not dilated (or "not visible").

The spleen is of normal size, homogeneous texture.

There are no volumetric formations in the region of the adrenal glands; on the left, the ultrasound picture is blurred. The aorta and inferior vena cava have normal contours. Retroperitoneal and pelvic lymph nodes are not enlarged. (Or: the retroperitoneal space is visualized caudal to the pancreas. The aorta and inferior vena cava are not changed, the lymph nodes are not enlarged.)

Abdominal ultrasound revealed no pathological changes. There are no signs of free fluid in the abdominal cavity.

The bladder is full, the walls are smooth, not thickened.

The prostate gland is of normal size, not changed. Seminal vesicles are not changed.

The shape and size of the uterus correspond to the age norm, there are no volumetric formations.

The ovaries are without features, the shape and size correspond to the age norm, no pathological volumetric formations in the ovaries were detected. (Or: the testicles are of normal size and echostructure, there are no pathological volumetric formations. The epididymis are without features.)

The thyroid gland is of normal size, the volume is X ml, the structure is homogeneous, no volumetric formations were detected. The parathyroid glands are not identified.

Lymph nodes on the lateral surfaces of the neck are not enlarged, oblong in shape, the dimensions correspond to the age norm, the maximum diameter is X mm.

You probably noticed that when describing the ovaries and cervical lymph nodes, the wording “without features” appears, although this wording is not allowed when evaluating the ultrasound morphological picture. The reason for it is the fact that even in healthy patients, small volumetric structures can be found in these formations (in the ovaries - small follicles that appear and disappear during ultrasound in certain phases of the menstrual cycle) or minor changes, such as reactive enlargement of lymph nodes neck without signs of disease. So that the description of the ultrasound results is not cumbersome and does not contain arguments about differential diagnosis, the need for which appears in about half of the cases, deviations from this rule are allowed for practical reasons.

Evaluation of the results crowns their description. It should be as concise as possible. Please note that often the doctor who referred the patient for an ultrasound is limited to only reading the evaluation of the results. It should include the following elements:

Conclusion and assessment of the main data, indicating additional studies, if necessary. For example: “Echogenic volumetric formation with a diameter of 3 cm in the right lobe of the liver, in the region of the VI segment. According to the ultrasound morphological features, it is most likely a hemangioma. Contrast ultrasound is recommended to confirm the diagnosis.

A clear answer to the question posed by the referring physician. A description of the results of an ultrasound scan of an oncological patient can be something like this: “The revealed focus is not typical for a tumor by ultrasound morphological features. A contrast ultrasound is recommended. There were no signs of tumor metastases in other parts of the abdominal cavity.

Conclusion on concomitant changes: "In the lower pole of the right kidney - a cyst with a diameter of 4 cm. Moderate sclerosis of the aorta."

A generalized description of the normal ultrasound picture: "There are no other pathological changes."

The evaluation of the results should contain summarized data, because doctors working in departments often transfer them verbatim into a medical report without subjecting them to in-depth analysis. The use of phrases and remarks such as "... the above data is most likely about ..." should be avoided, as they do not contain specific information for the doctor who will read such a conclusion. If, in general, any pathology was absent during ultrasound, it is necessary to express this in a brief formulation, without forgetting, however, to answer the question posed by the doctor, for example: “The ultrasound picture is normal, there are no signs of metastases.”

Transvaginal ultrasound (TVUS) is one of the methods for diagnosing the condition of the pelvic organs in women, carried out with a special device through the vagina. It is recommended in cases where it is necessary to assess the condition of the female genital organs from the inside, it is usually carried out in conjunction with a gynecological examination and the usual usual ultrasound of the abdominal cavity from the outside. The study of organs in this case (namely, their structure, shape, presence or absence of pathologies) is carried out using an ultrasound signal, the results of which are sent to the monitor through a special sensor for evaluation by a specialist. The signal "from the inside" is more informative, since with a conventional ultrasound of the pelvic bone and an unsuccessful angle can interfere with the passage of ultrasound and distort the clinical picture, the same happens in overweight women, fat deposits in a significant amount do not allow the signal to pass. In addition, intravaginal ultrasound makes it possible to examine in more detail the internal structure of the organs under study. It is usually prescribed by a gynecologist, but it would be useful to undergo it for prevention at least once every few years, this procedure is absolutely harmless and painless, but is important for the timely detection of pathologies.

Gynecological ultrasound is performed with the aim of:

• a detailed study of the anatomy of the uterus, when it is necessary to assess the length of the cervix or the shape and size of its body, the structure of its inner layer, its thickness;
• to diagnose the physiological state of the ovaries, their shape, size, structure, functionality;
• if you suspect the occurrence of polycystic and oncological neoplasms;
• with artificial insemination, for the most accurate assessment of the location of organs when extracting an egg from the ovary and then placing it in the uterus;
• for diagnosis in case of suspected ectopic pregnancy and to establish the cause of possible spotting or bleeding of all types.

When to do TVD ultrasound

Women can do a TVD study at any period of the cycle, but it is usually prescribed immediately before the onset of menstruation, when the uterus noticeably increases in size and is located exactly in the middle of the pelvis. Ultrasound before menstruation shows various deviations from the norm in the most detail. These include:

1. Benign oncological diseases, such as fibroids, which are easily eliminated and quickly treated, if they are detected in the early stages, the sooner the treatment will be more effective and faster.
2. Endometritis, namely the symptoms characteristic of them, are small fluid-filled cavities among the muscle fibers. In this case, the doctor prescribes additional studies before making a final diagnosis.
3. Malignant neoplasms such as cervical erosion or cervical cancer. In addition, ultrasound shows not only the size or location of a possible tumor, but also allows you to assess the extent of its impact on nearby organs.
4. Cysts and polycystic ovarian formations, since before menstruation, when the egg matures, they can increase in size and are easier to detect.
5. Ectopic and frozen pregnancy, some pathologies in the development of the fetus. It is also possible to diagnose a normal pregnancy and evaluate its course.

How does TVD ultrasound work?

One of the pleasant aspects of such a study is the lack of preparation for transvaginal ultrasound. No special procedures are needed, you do not need to starve or drink three liters of water, observing general hygiene standards when going to the gynecologist will be enough. There are quite a few exceptions to this rule, or rather, cases when you still have to prepare for a transvaginal ultrasound, namely:

• During pregnancy, for an accurate assessment of the state of the organs, it is necessary to fill the bladder an hour and a half before the ultrasound. One or two glasses of water will be enough. In other cases, the bladder should be empty and it is undesirable to drink water before the ultrasound.
• Remove from the diet products that contribute to the formation of gases, bloating, as excess air can lead to distortion of the results and blur the picture.

Many women are concerned about the question of whether it hurts to do such a study. Answer - No, transvaginal ultrasound of the uterus is absolutely painless, maximum you can feel a slight discomfort from a foreign object. The whole procedure takes place as follows: the woman undresses below the waist and lies down on the couch, trying not to move during the procedure, with her stomach up, the doctor puts a condom on the rod of the device (it is small, up to 12 cm long and approximately 3 cm in diameter), lubricates it with a special gel, after which it is slowly inserted into the vagina. You do not need to carry a condom for the ultrasound sensor with you, they are among the instruments of doctors and are included in the cost of the procedure, as well as disposable towels, a couch cover, shoe covers, gloves, etc. not in private, it is better to call and find out in advance what you need to have with you for this procedure.

As the name of the procedure implies, it occurs intravaginally, which means that a sensor that sends ultrasonic waves is inserted into the woman's vagina, you should be prepared for this in advance.

If suddenly during the insertion of the sensor you experience unpleasant painful sensations, this may be the result of muscle contraction, for example, when a girl is afraid and came to this procedure for the first time. In this case, try to relax as much as possible, distract from what is happening, otherwise you will complicate the work of the doctor and delay the procedure, which normally is no more than 15-20 minutes. If you are relaxed, but there are still painful sensations, it is better to report this, this happens with severe inflammation, and the doctor needs to know all the nuances to make the correct diagnosis.

Inside, vaginal ultrasound is done exclusively for women who are sexually active, this procedure is not used for virgins, they are given a regular, “external” ultrasound.

Decryption

1. the location of the organ (normally there should be a slight forward tilt).
2. the contours of the uterus (normally they should be even and clear, otherwise this is an indicator of inflammatory processes or the presence of neoplasms).
3. the size of the uterus (the ideal ratio of length/width/diameter is considered to be 7/6/4 cm, if it is less, it is called the "children's uterus", and if more, it indicates the presence of pathologies).
4. the echogenicity of the walls (the ease of passage of the signal through them), ideally should be homogeneous.
5. the thickness of the endometrium (the inner layer of the uterus), depending on the day of the cycle, is from 0.3 to 1.6 cm, it reaches the largest parameters before the onset of menstruation.
6. the cervix should normally be about 4 cm long, with a cervical canal filled with a homogeneous echostructure.
7. ovaries normally should not exceed 7-8 cm3 in volume, with follicles 5-20 mm in size, depending on the degree of maturation.
8. the contours of the ovaries may be indistinct, but bumpy, and the echostructure is heterogeneous, with small patches of fibrous tissue.
9. the diameter of the fallopian tubes does not exceed 3-4 mm, but normally they are not visible on a non-contrast ultrasound, otherwise it is a sign of inflammation.

Any deviations from the above indicators indicate the presence of diseases of both an inflammatory nature and pathologies associated with the appearance of cysts and tumors.

If you do an ultrasound without a doctor's prescription, on your own initiative, for the purpose of prevention, or because of any disturbances in the functioning of the genital organs, you should be aware of the dangers of self-treatment. If you are not a practicing gynecologist, you will not be able to independently interpret the results of the analysis and prescribe the correct treatment. If any deviations from the norm are found in the results, it is impossible to delay the start of treatment, some diseases are very dangerous and, if not treated in time, can lead to irreversible changes, even death.

It is worth taking into account the fact that ultrasound itself, even very accurate and modern, does not carry all the information about the current clinical picture. It is necessary to undergo a full examination by a gynecologist, take tests, and sometimes additional ultrasound for an accurate and correct diagnosis. And even in this case, the doctor may prescribe additional tests, for example, or a hormone test to determine the treatment regimen.

Proper diagnosis of the disease is already halfway to its cure, which is why it is so important to use modern and fast methods in this process. So, if the organs in the abdominal cavity are disturbed, an ultrasound examination is a procedure that cannot be dispensed with. Find out what signs of possible diseases the analysis can show.

What is included in an abdominal ultrasound

This type of diagnostics is used very widely today, because the abdominal cavity contains the internal organs of a person responsible for various functions of the body. With ultrasound of the OBP, they examine:

• gastrointestinal tract, which includes the stomach, intestines;
• pancreas;
• lymphatic organs: spleen, abdominal lymph nodes;
• gallbladder;
• liver;
• retroperitoneal space: kidneys and adrenal glands, abdominal aorta, inferior vena cava;
• urinary organs: ureters and bladder, prostate gland in men, uterus and appendages in women.

With the help of ultrasound, a doctor can quickly obtain detailed information about the state of the organ in question, and for the patient, such manipulations are painless and harmless. Deciphering the data of this study helps to timely identify various pathologies that have begun to develop in the body, for example:

• organ cyst;
• single or multiple abscesses;
• swelling in the abdomen;
• fluid in the abdominal cavity;
• malformations of the fetus during pregnancy.

The size of the spleen is normal

The main reason when a doctor examines this organ in detail is its enlargement. Ultrasound of the spleen should also be done if the patient had an abdominal injury and there is a suspicion of its rupture and internal bleeding. The doctor needs to evaluate:

• Do the contour and dimensions of the organ differ from the norm, which for adults are:
  • thickness - 4-5 cm;
  • width - 6-8 cm;
  • length - 11-12 cm.
• Calculate the area of ​​the spleen; for this characteristic, indicators from 15.5 to 23.5 square meters are considered normal. cm.
• Are there neoplasms and tissue damage.
• How is it located relative to adjacent organs.

What does an ultrasound of the stomach show?

Such a study is often prescribed not only if the patient complains of pain in the organ, but also as a preventive measure for the timely detection of an incipient disease or to evaluate the results of the treatment. When deciphering the ultrasound of the abdominal cavity, close attention is paid to data on the state of the stomach, because with such a diagnosis it is possible to identify:

• hiatal hernia;
• esophagitis - an inflammatory disease of the esophageal mucosa;
• gastroesophageal reflux disease;
• tumors;
• if necessary, detect foreign bodies.

Although this type of diagnosis in certain cases will not replace an endoscopic or x-ray examination, a doctor cannot do without it when monitoring the chronic course of certain diseases, for example, gastritis or peptic ulcer. When decoding ultrasound of the gastrointestinal tract in a quick and painless way, determine:

• swelling of the walls of the organ and the lack of delimitation of the wall;
• stomach ulcer;
• enlarged due to varicose veins;
• diffuse neoplastic wall thickening;
• pyloric stenosis - congenital or acquired;
• gastric carcinoma ;
• lymphoma and other dangerous diseases.

Normal size of the liver on ultrasound in adults

This organ consists of two unequal lobes, and normally it should have a homogeneous echostructure and be interrupted only by the portal vein and branches of this blood vessel.
An important criterion that is paid attention to in the diagnosis is the compliance of the liver with such parameters defined for adult patients:

• length:
  • glands - 14-18 cm;
  • right lobe - 11-15 cm;
• size in diameter - 20-22.5 cm;
• right lobe, oblique vertical size - up to 15 cm;
• the height of the left lobe - up to 10 cm;
• sagittal size - from 9 to 12 cm;
• share thickness:
  • right - up to 12.5 cm;
  • left - up to 7 cm.

What does a liver ultrasound show? If, when deciphering the results, an increase is indicated, this clearly indicates the development of pathological processes in it, for example, cirrhosis or hepatitis. Also an important indicator is that the shape of the lower angle of the organ should be pointed: in the region of the left lobe - no more than 45 degrees, in the right - no more than 75 degrees. When diagnosing, you need to pay attention to the visualization of the vessels passing through the liver, because one of the main functions of the gland is blood filtration.

An ultrasound examination looks at the structure of the liver and how clear and even the contours of the organ are, whether the sound conductivity of the gland is good. Deviations in the values ​​of these parameters always indicate the presence of problems in the work of the body. So, if during the diagnosis an increased density is visible, we can talk about diffuse changes and dysfunction of this natural filter. With ultrasound diagnostics, it is possible to consider calcifications in the liver - deposits of calcium salts that have arisen after the patient has suffered serious diseases.

What does an ultrasound of the kidneys show?

These paired bean-shaped organs perform the function of cleansing the body of harmful substances by removing them together with a human waste product - urine. Deciphering the ultrasound of the abdominal cavity always includes their parameters such as structure, shape, location. The right kidney should be placed slightly lower than the left, and the difference in their sizes should not exceed 2 cm. Normal for an adult are such figures characterizing the parameters of these urinary organs:

• length - 10-12 cm;
• kidney thickness - 4-5 cm;
• width - 5-6 cm;
• parenchyma thickness - up to 2.3 cm.

With ultrasound of the kidneys, such violations in their functioning can be detected:

• anomalies of blood vessels: narrowing of the renal artery, the appearance of additional veins;
• the formation of kidney stones;
• chronic pyelonephritis - the process of inflammation of the tissues of the organ, which leads to a violation of the normal outflow of urine;
• expansion of the renal pelvis - pyelectasis;
• cyst;
• tumors: benign or malignant.

Gallbladder size, normal in adults

This pear-shaped organ is located at the bottom of the liver in a separate recess and is closed by the peritoneum from the side of the abdominal cavity. It collects bile produced by the liver, and then regulates its supply to the digestive tract. Deciphering the ultrasound of the gallbladder gives an idea of ​​its shape, size, condition of the walls, volume and internal contents. For adult patients, the following indicators are considered normal, identified during the examination:

• the distance from the bottom of the bubble to the narrowest lobe is 6-10 cm;
• organ width - up to 5 cm;
• wall thickness - does not exceed 4 mm;
• the volume varies from 30 to 50 ml.

common bile duct

When deciphering the ultrasound of the abdominal cavity, attention should be paid to the data on this tubular formation, which doctors also call choledoch. The length of the bile duct can vary from 2 to 12 cm. The inner diameter of the common bile duct in different parts of this formation can be from 2 to 8 mm. The doctor needs to consider whether this value does not exceed 8 mm in the widest part of the formation. By deciphering the ultrasound diagnosis of the common bile duct, a specialist can see the stones formed in it and establish a diagnosis of choledocholithiasis.

Ultrasound of the pancreas

The importance of examining this organ is explained by the fact that insulin is synthesized in it, and timely noticed deviations in its work make it possible to take measures to prevent serious pathological changes in the body. When deciphering the research data, you need to pay attention not only to the size of the pancreas, but also to its echogenicity (image brightness) and the clarity of the contours. All parts of the gland should be well visualized on the screen:

• head - normally its thickness does not exceed 3.2 cm;
• organ body - up to 2.5 cm;
• tail - up to 3.0 cm.

The uzist should carefully examine the diameter of the Wirsung duct. This indicator should normally be 1.5-2 mm, and in response to the introduction of intravenous secretin, expand to 2.5-5 mm. The expansion of the Wirsung duct or the lack of response to the intake of this hormone indicates the development of an inflammatory process - pancreatitis. Often, deformations in this zone occur during the development of a tumor of the head of the pancreas. An experienced doctor will be able to see abscesses, areas of necrosis and the presence of stones that clog the ducts with an ultrasound examination of the organ.

How to decipher the results of an ultrasound

An independent analysis of ultrasound data for a person without special medical education in the vast majority of cases will not reveal a clear picture of his state of health. A complete and accurate interpretation of the abdominal ultrasound should be carried out either by the ultrasound doctor or by the attending doctor who referred the patient for such an analysis.

Only the specialist conducting the study sees in real time the work of the organs, how mobile they are, how blood circulates through them. For a complete and correct interpretation of the data in order to make a diagnosis, a doctor must take into account a whole range of factors in total:

• the exact location and size of all organs;
• the structure of their tissues;
• possible presence of deformations;
• signs indicating chronic diseases;
• the presence of tumor benign or malignant neoplasms.

Video: what shows the ultrasound of the intestine