Real-time Ultrasound Imaging in the Abdomen
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1 Real-time Ultrasound Imaging in the Abdomen
2 Real-time Ultrasound Imaging in the Abdotnen M. Leon Skolnick, M. D. Associate Professor of Radiology University of Pittsburgh School of Medicine Director of Ultrasound Laboratories Presbyterian-University Hospital Pittsburgh, Pennsylvania With 386 Illustrations Springer-Verlag New York Heidelberg Berlin
3 M. Leon Skolnick, M.D. Associate Professor of Radiology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania U.S.A. Sponsoring Editor: Larry W. Carter Production and Design: Berta Steiner Library of Congress Cataloging in Publication Data Skolnick, M. Leon. Real time ultrasound imaging in the abdomen. Bibliography: p. Includes index. 1. Abdomen-Radiography. 2. Diagnosis, Ultrasonic. I. Title. [DNLM: 1. Ultrasonics-Diagnostic use. 2. Abdomen. WI 900 S628rJ RC944.S56 617' AACR by Springer-Verlag New York Inc. Softcover reprint of the hardcover 1st edition 1981 All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010, U.S.A. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone ISBN-13: DOl: / e-isbn-13:
4 Dedications To the memory of my father) Samuel) who inspired me to write this book) and to my family-irene) David) Karen) and Eric-who encouraged and supported me through these endeavors
5 Contents 1 Advantages of Real-time Imaging Instrumentation Scanning Techniques and Anatomic Considerations Kidney Liver and Spleen Biliary System III 7 Pancreas Retroperitoneum Intra- and Extraluminal Fluid Invasive Ultrasonography..., 213 Index vii
6 Preface Diagnostic ultrasound is changing dramatically because of the development of a variety of high resolution real-time scanning instruments. Until recently the standard instrument was the articulated arm contact scanner. Real-time scanners were viewed as adjunct instruments for specific and limited purposes. The roles are reversing with real-time instruments more frequently accepted as the primary diagnostic tool and the contact scanner becoming the ancillary instrument for use mainly for viewing a large field that cannot be scanned with real-time instruments. Two recent editorials stated that real-time instruments were used as the sole diagnostic instrument for between 80% [Cooperberg (2)] and 98% [Bartrum and Crow (1)] of their abdominal examinations. This book introduces the reader to the field of real-time scanning in the abdomen. It presupposes an understanding of basic physical concepts of ultrasound, the appearance of both normal and pathologic conditions as produced by static articulated arm contact scanning, and a familiarity with the techniques of contact scanning. It is designed to acquaint the reader with the spectrum of real-time instrumentation, provide a basic understanding of the physics of ultrasound as related to these instruments, emphasize the special skills required in the use of this equipment, and describe applications of real-time scanning for various parts of the abdomen. While numerous illustrations of both normal and pathologic anatomy are shown, the book is an all-inclusive study of abdominal pathology as demonstrated by real-time imaging. Obstetrics and gynecology were intentionally omitted from this work. I believe that these subjects are sufficiently broad that adequate coverage would require publication in a separate book. The adrenal gland was excluded because our experience with real-time studies of this organ was quite limited. Unless otherwise noted, all of the ultrasound images in this book are printed so that: 1) on transverse scans, the right side (R) of the subject is on the viewer's left; and (2) on sagittal scans, the direction of the subject's head (H) is on the viewer's left. ix
7 x REFERENCES 1. Bartrum R], Crow HC: Real-time ultrasound: Its role in abdominal examinations. Radiology 133: , Cooperberg P: Real-time ultrasound of the abdomen: Clinical usefulness and limitations. Appl Radiology, p. 130, November-December, 1980
8 Acknowledgments The WTiting and producing of a book involves many people in addition to the author. Several persons who have been especially vital to the success of this project and whom I wish to individually acknowledge and thank for their efforts are: Janice French, my devoted secretary, for typing and organizing the manuscript; Denise Basara, Abbe Greenberg, and Lois Galentine, our excellent technologists who worked with me in performing the ultrasound examinations; Jon Coulter and Ron Filer, for the artwork; Norman Rabinovitz and his staff for photographic support; and Larry Carter, Berta Steiner, and Ute Bujard of Springer-Verlag for producing this volume. M. Leon Skolnick, M.D. Pittsburgh, Pennsylvania xi
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