Biliary ultrasound: Difference between revisions

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==Measurements==
==Measurements==
*GB wall is normally <3-4mm
*GB wall is <4 mm + 1 mm/decade
**Measure the ant wall with a short-axis view
**Measure the anterior wall at narrowest point with a short-axis view
**Causes:
**Causes:
***1. Acute cholecystitis
***1. Acute cholecystitis
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**identify by hypoechoic "shadowing" behind hyperechoic stones
**identify by hypoechoic "shadowing" behind hyperechoic stones
***if no shadowing, may be polyps, sludge, etc.
***if no shadowing, may be polyps, sludge, etc.
**SIN Sign: Stone-in Neck


*Common Bile Duct
*Common Bile Duct
**Measure from inner to inner
**Measure from inner to inner
**Normal is up to 4mm to age 40 (add 1mm per decade thereafter)
**Normal is up to 4 mm to age 40 (add 1mm per decade thereafter)
**Mickey Mouse Sign: Portal Vein (face), CBD (right ear), and hepatic artery (left ear)
***Color doppler will demonstrate the vein and artery


*Acalculous cholecystitis
*Acalculous cholecystitis

Revision as of 19:06, 31 December 2014

Technique

  • Can use phased array or convex probe
  • Look in midclavicular line at Right 11th/12th intercostal spaces or scan anteriorly from Morrison's pouch
  • Patient in Left lateral decubitus (if can tolerate)
    • Allow for better visualization of gallbladder (moves gallbladder anteriorly)
    • Better visualization of gallstones

Findings

Evaluate gallbladder for:

  1. GB wall measurement
  2. Pericholecystic free fluid
  3. Gallstones
  4. Common Bile Duct (CBD) measurement
  5. Sonographic Murphy's (pain with ultrasound probe palpation over gallbladder)

Measurements

  • GB wall is <4 mm + 1 mm/decade
    • Measure the anterior wall at narrowest point with a short-axis view
    • Causes:
      • 1. Acute cholecystitis
      • 2. Ascites
      • 3. CHF
  • Gallstones
    • identify by hypoechoic "shadowing" behind hyperechoic stones
      • if no shadowing, may be polyps, sludge, etc.
    • SIN Sign: Stone-in Neck
  • Common Bile Duct
    • Measure from inner to inner
    • Normal is up to 4 mm to age 40 (add 1mm per decade thereafter)
    • Mickey Mouse Sign: Portal Vein (face), CBD (right ear), and hepatic artery (left ear)
      • Color doppler will demonstrate the vein and artery
  • Acalculous cholecystitis
    • GB is >10cm long & >4 cm wide

See Also

Source

Sonoguide