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SOUNDWAY, INCORPORATED P.O. Box 126 Media, PA 19063 Abdominal & Small Parts Sonography A Comprehensive Study ISBN 978-1-4951-0847-1 Copyright 2014, SoundWay, Incorporated. All rights reserved. No part of this publication may be reproduced, transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission, in writing, from the publisher. International Standard Book Number 0-9 Printed in the United States of America. Last digit is the print number: 9 8 7 6 5 4 3 2 1 iii
About the Author: Barbara Annunziato is an educator and sonography consultant, in Media, Pennsylvania, who has worked in the sonography field for over 30 years. Since 1999, she has served as program director of an accredited sonography program, while still keeping her hands in clinical scanning. She also served as a JRC-DMS site visitor for ten years and has worked with both the ARDMS and ARRT to help improve the sonography boards. Barbara completed undergraduate work in instructional methods at Widener University. Her Masters of Education in Adult Learning, Training, and Development was obtained from Regis University. iv
Acknowledgements To my dear friend and colleague Nate Pinkney there are no words to describe my gratitude for your guidance and support. To my beloved teacher, Joe Darby, my ole blue eyes, who had the patience of Job. To Larry Waldroup, my ob/gyn teacher - you are a fountain of knowledge. Thank you for your generosity with the use of images from Sono World, such a wonderful resource for the field. To Tim Gibbs, a generous colleague with a phenomenal image library. To Candi Roth - thank you for challenging me to do online lectures and making me a believer that vast amounts of material can be fit into small packages. And last, but definitely not least, to my husband, John, for his support over the past several years, while working on this project. Anatomical pictures not referenced are from Wikipedia Commons. v
Preface You will notice that for most of the sections, I dedicated one chapter to normal and the following to pathology. During my career, I have chosen to teach the students normal one semester and abnormal the next. I find that if the students get a good feel for what normal looks like, they are better able to identify abnormal. You will have the flexibility of customizing your study habits, according to what works best for you. This collection of essential material can be used as an effective tool for reinforcement in sonography education. It is a comprehensive study of the information required to perform abdominal sonography and the Power Point format provides easy access to key points. I believe that investigation and research contribute greatly to learning and additional reading is always suggested. You will also notice that some basic, but important information is stressed more than once. I would like to remind you that protocols and measurements may vary per institution. The slides are presented in a left to right format. Additional color plates can be found at the end of the book and are numbered, according to page. Note the icon on images that are included as color plates. vi
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Chapter 2 Normal Liver Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Recognize normal sonographic liver anatomy, Acquire appropriate ultrasound images of the liver, Describe the sonographic findings of the liver, Discuss lab values pertaining to the liver, and Utilize proper ergonomics for scanning. 1
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Chapter 7 Abnormal Biliary System Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Associate elevated lab values with disease, Recognize abnormal sonographic biliary anatomy, Describe the sonographic findings, Document abnormal findings, and State differential diagnoses. 3
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Chapter 9 Abnormal Pancreas Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Associate elevated lab values with disease, Document abnormal pancreatic anatomy, Describe the sonographic findings, and State differential diagnoses. 5
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Chapter 10 Normal Urinary System & Adrenal Glands Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Describe the anatomic location and structure of the kidneys, ureters, bladder, urethra, and adrenal glands, Explain the physiology, Describe the normal sonographic anatomy, Associate elevated lab values with disease, Discuss the appropriate scanning protocol, and Utilize proper ergonomics for scanning. 7
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Chapter 11 Abnormal Urinary System & Adrenal Glands Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Describe congenital anomalies of the kidneys, Discuss the causes of hydronephrosis, Discuss renal cystic disease, Describe the sonographic appearance of benign and malignant neoplasms, Explain the infectious processes, and Define the sonographic findings of renal vascular diseases. 9
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Chapter 17 Normal Scrotum Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Explain basic anatomy of the scrotum, testes, and related structures, Describe techniques for image acquisition, Identify sonographic anatomy, and State the protocol for evaluation of the scrotum. 11
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Chapter 19 Normal Prostate Gland Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Explain basic anatomy of the prostate gland and related structures, Describe techniques for image acquisition, Identify sonographic anatomy, and State the following for prostate scanning: - Indications, - Approach, - Orientation, and - Protocol. 13
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Chapter 23 Normal Breast Sonography Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Explain the anatomy & physiology of the breast, Determine appropriate ultrasound uses, Label breast ultrasound images correctly, Describe examination techniques, Recognize the sonographic appearance of normal breast structures, and Determine the expected location of a lesion on ultrasound versus mammography. 15
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Chapter 28 Sonography of the Penis Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Describe basic anatomy of the penis, Explain the blood supply, State the reasons for performing an exam, Discuss physiology, Contribute to the interpretation of the exam, and Describe the sonographic findings. 17
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Chapter 29 Sonography of the Neonatal Hips Objectives Upon completion of this section, the attendee should be able to have a general understanding of how to: Identify the anatomy of the neonatal hip, Describe the appropriate protocol for neonatal hip sonography, Describe the risk factors for developmental dysplasia of the hip, and Discuss the sonographic interpretation of this procedure. 19
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