the kidneys are _______ and located on either side of the spine between T12 and L4.
_____ to the kidneys is the quadratus lumborum and psoas major muscles.
psoas is associated with the ___ pole of the kidneys.
upper (upper psoas [UP] or superior psoas)
quadratus lumborum is associated with the ____ pole of kidneys.
lower (lower lumborum)
renal sinus is ______ compared to the ______ renal cortex.
the renal pelvis and major calices are sometimes referred to as the renal ____.
what is anterior to the right kidney?
rt adrenal gland, rt lobe of liver, second part of duodenum, hepatic flexure of colon, and jejunum.
the ___ _____ cover the rt kidney superior-medially.
the rt lobe of the liver is covered ____ by the rt. kidney.
the second part of the duodenum covers the rt kidney _____.
what also covers the rt. kidney medially?
hepatic flexure and jejunum
what is anterior to the lt. kidney?
pancreatic tail, lt. adrenal gland, spleen, jejunum, stomach, and splenic flexure of colon.
which anterior structure covers the lt. kidney medially?
which anterior structure covers the lt. kidney laterally?
which ant. structure covers the lt. kidney superior-medially?
the spleen covers the lt. kidney _____
the jejunum covers the lt. kidney ____.
the ____ is covered by the lt.kidney superiorly.
which structures are posterior to the kidneys?
diaphragm, psoas muscle, transversus muscle, and quadratus lumborum
The diaphragm is post. and ____ to the kidneys.
the psoas muscle is post. and ____ to kidneys.
the transversus m. is post. and ______ to the kidneys.
which posterior structure is between the lateral and medial portions of the kidneys.
The ureters are ___.
the ureters extend ______ along the psoas m.
the ___ ___ is post. to the duodenum, terminal ileum
which structure is post. to the colon?
which portion of the ureters passes anteriorly to the psoas m. and the bifr. of the CIA's?
the ureters empty ____ into the u. bladder.
anterior to the bladder is the ___ ____.
the male bladder is ___ to the seminal vesicles and rectum.
the male bladder is ___ to the prostate.
the female bladder is ___ to the vagina, post. cul de sac, and rectum.
The ___ exits inferiorly from the bladder.
the male urethra is longer than the females. T/F
Normal measurements of the kidneys are...
9-12 cm length; 2.5-4cm anterioposterior, 4-6 cm width
renal anomalies include the dromedary hump which is...
a lateral bulge of the lt. kidney
fetal lobulations are...
small, often isolated, cortical indentations.
a hypertrophied column of bertin may...
extend to renal sinuses
a duplex collecting system is...
divided partially or completely by renal cortical tissue.
kidneys that fail to separate and migrate properly are called...
horseshoe kidneys generally fuse at the ____ ____ and drape over the great vessels.
which retroperitoneal gland is difficult to see in adults?
where are the adrenals located?
at the anterior, superio/medial borders of the upper poles of the kidneys
the rt. adrenal is located posterolateral to the ___.
the rt. adrenal gland is ____ to the rt. lobe of liver.
the rt. adrenal is anterolateral to the what?
rt. crus of diaphragm
the lt. adrenal is __ to the panc. tail
the lt. adrenal is found on the same plane as the spleen and what 2 other things?
upper pole of kidney and the aorta at the same time
normal measurements of the adrenals are?
2 in length, 1 in width, .4 in anterioposterior
What is composed of a right and left lobe connected by an isthmus, superficial, and found inferior to the larynx and anterior to the trachea?
lobes bounded laterally by the _____ (artery. more medial) and the _______ (vein, more lat.)
common carotid artery, internal jugular vein
lobes bounded medially by the?
lobes bounded anterolateral by the
strap muscles and sternocleidomastoid muscles
strap muscles consist of the
sternohyoid, sternothyroid, omohyoid and thyrohyoid muscles
lobes bounded posteriorly by the
longus colli muscle, esophagus and minor neurovascular bundle
minor neurovascular bundle consists of the
inferior thyroid artery and recurrent laryngeal nerve
minor neurovascular bundle lies between the
longus colli muscle and the thyroid
major neurovascular bundle consists of the
CCA, IJV, and the vagus nerve and is encased by the carotid sheath
Normal Measurements of thyroid
4 to 6 cm length
2 to 3 cm anteroposterior
1.5 to 2 cm width
larger in women than men
increases in size with age
isthmus measures 2 to 6 mm anteroposterior
Regulates Iodine metabolism
Two pairs of parathyroid are
superior & inferior
posterior to the middle third and lower third of the thyroid
superior set of the parathyroids are more
posterior & medial than the inferior set
Physiology of parathryroid
Regulate calcium metabolism
Localizing the parathyroids
longus colli muscle
common carotid artery
area between this anatomic triangle should be free of any masses
Normal Measurements of parathyroid are?
length 5-7 mm
width 3-4 mm
anteroposterior 1-2 mm
Sonographic Appearance of parathryoid?
not normally seen by sonography
Normal Variants of parathyroid
thirteen to fifteen percent of the population has five parathyroids
five percent have three parathyroids
fifteen to twenty percent have ectopic parathyroids
5 layers of GI wall are?
inner surface, composed of epithelium
connective tissue, contains blood vessels and lymph
circular & longitudinal muscle bands
loose connective tissue
Sonographic Appearance of GI walls is?
layers 1, 3 and 5 are echogenic
layers 2 & 4 are hypoechoic
total thickness =< 5mm (undistended)
when empty displays a target sign
when filled with air of gas, reflective shadowing will be produced
What is seen with Ultrasound? In the Abdomen:
What is seen with Ultrasound? Other Places in GI:
What is seen with Ultrasound? Normal bowel:
if filled with gas or air will demonstrate reflective shadowing
if filled with fluids may demonstrate internal rugal folds
when empty bowel wall = 2-6 mm
if extended bowel wall = 2-4 mm
The scrotum is what?
a sac divided into two compartments by median raphe
each contains a testi, epidiymis, some spermatic cord & ductus deferens
left sided usually more inferior than Rt
made of tunica vaginalis
The Testis are:
oval & slightly flattened
UP more ant. than LP
4-5 cm long
2.5-3 cm M/L
lie anterior to epididymis
head is superior
Anatomy to Note of the testis:
head, body, tail
union of septa, ducts, nerves & vessels
union of tubules
head, body, tail
anatomy of testicle
head of epidiymis
tail of epididymis
Note: if connection to abdomen does not fuse--a congenital hernia develops
ductus deferens, nerves & vessels
produce male sex hormones (testosterone)
Normal Sonographic Appearance
mid to high gray levels
Testicular and Scrotal Variants
Location of breast:
paired dome-shaped structures lying along the anterior chest wall next to the axilla
anterior to the pectoralis major/minor, and external oblique muscles and the sixth rib
lateral to the sternum
medial to the margin of the axilla
majority of the glandular tissue lies in the upper outer quadrant and subareolar
Sectional anatomy of the breasts
Sonographically we see three layers
describe each layer. of the breast
skin, subcutaneous fat
glandular tissues, duct, connective tissue
retromammary fat, muscle, deep connective tissue
Linear echogenic structures
Found primarily in the subcutaneous layer of the breast
Give support to breast parenchyma
Significant lymphatic supply
Tail of Spence
Documentation Techniques of breast
Documented as a clock system
Plus nipple and axilla
Documented in a zonal system
Film Annotation of breast
Labeling your films can be very time consuming. Most ultrasound departments utilize the clock method. In our lab we also use the ABC and 123 to label the exact location of a lesion. This is particularly helpful if you need to follow-up a lesion of is the patient is sent to another facility for a biopsy.
First a clock position is stated. Secondly, the location of the lesion is noted. There are five possible choices for the 123, location. 1 through 3 is divided into 3 concentric rings. If a lesion is near the nipple, this location is 1, mid way out in the breast is 2 and in the periphery is 3. If a lesion is under the nipple we label this area SA for subareolar and lesions in the axilla are labeled AX.
For the ABC; A, is if a lesion is near the surface or close to the transducer. B is mid way down (and represents the mammary zone) in the breast and C is against the chest wall.
Film Annonation of breast, cont
Diagram of a right breast lesion about 4 cm directly superior to the nipple and 3 cm deep
Which was scanned in a radial plane would typically be described as "Rt 12 2C RAD".
The left breast lesion in the upper outer quadrant about 6 cm from the nipple and near the
chest wall which was scanned in an anti-radial plane would be labeled "Lt 1:30 3C AR".
skin 2-3 mm
ducts 2mm or less unless they are at the lactiferous sinus
lactiferous sinus - focal enlargement of the main collecting duct from each lobe just posterior to the nipple
Normal variants of breast
fibrocystic - various fibrotic components and cystic areas are seen throughout the breasts
Fibrous breast - primarily composed of dense fibrous components
fatty - fatty components increased with decreased echogenicity throughout the breast
deposition of fat increases with age and parity
Well visualized with mammography
Sonographic Appearance of breast
mammary layer demonstrates the greatest changes by ultrasound due to the natural process of aging
younger breast - higher ratio of parenchyma to fat
dense breasts are hard to see by mammogram, younger pts. with palpable masses should first have an ultrasound
Sonographic Appearancecontinued in older patients:
older pts. - breast undergoes fatty replacement, the breast now has a higher ratio of fat to breast parenchyma
older, nulliparous women may retain a good amount of glandular tissue
MAIN ROLE OF US IN BREAST IMAGING
ability to differentiate between cystic and solid masses