腹部超声检查大全(b超)（Abdominal ultrasonography (B Ultrasound)）

腹部超声检查大全(b超)（Abdominal ultrasonography (B Ultrasound)） 腹部超声检查大全(b超)(Abdominal ultrasonography (B Ultrasound)) Abdominal ultrasonography (B ultrasound) Abdominal ultrasonography (B ultrasound) 1 、 basic knowledge of ultrasonic (1) physical properties of ultrasonic waves Ultrasound is an acoustic wave with frequencies higher than KHZ (kHz). Because the frequency of ultrasound exceeds the auditory range of the human ear, the human ear cannot feel sound. Ultrasound has all the physical properties of sound waves, but its frequency is high and its wavelength is short. There are many ways to produce ultrasonic waves. The generation of modern ultrasound is mainly based on the special physical properties of some crystals (such as quartz, potassium tartrate, lead zirconate titanate, etc.) - piezoelectric effects produce ultrasonic waves. Because of the shorter wavelength of the ultrasonic wave and near the wavelength of the infrared beam, the ultrasonic beam has a strong directionality like the light and forms an ultrasonic beam. In ultrasonic technology, the ultrasonic wave is detected from the hair and enters the human body, and a supersonic beam with a width about the diameter of the probe is formed in a region closer to the probe. This region is called the near-field. In the near field, the ultrasonic beam is gradually broadened, which is called the far field. The reflection, refraction and scattering of ultrasonic wave, when the ultrasonic wave encounters two different mediums in the course of propagation, will produce reflection at the interface of medium. After ultrasonic reflection on the interface, the ultrasonic wave of the remaining energy will enter the second medium, called transmission. If the velocity of the sound in the two medium is the same, the direction of the transmitted beam will be equal to the direction of the incident beam. But if the speed of sound in the two medium is different, the transmission beam will take the direction of the transition, known as refraction. The rest of the energy will propagate from one center to the other in space, called scattering. The intensity of echo signals scattered back into the probe is markedly attenuated. Ultrasonic absorption and attenuation of ultrasonic wave propagation in the body, the intensity will be reduced as the transmission depth of the attenuation, known as attenuation. The attenuation of ultrasound in vivo is caused by ultrasonic reflection, scattering and ultrasonic absorption. (2) sonogram of ultrasound; The probe of ultrasonic diagnostic instrument is also called transducer. It converts electric energy into sound energy and generates ultrasonic waves. The ultrasound beam enters the human body after the encounter of two different media, reflected in the interface of the interface, called the echo, the remaining energy continues, so when you encounter different media interface and reflection, and so on. The ultrasonic diagnostic instrument also uses the echo of each layer of the human body's parts to be recovered into the instrument through the probe, and converts the sound energy into electrical energy, and displays it on the fluorescent screen to become a sonogram. Therefore, the sonogram can indirectly reflect the structure of each layer of a human body. (3) B type ultrasonic diagnostic apparatus There are two ways to echo echo size. One is through the waveform to respond, the amplitude of the waveform (that is, height), big echo is strong, but vice versa. This type is also called amplitude type, and the English word is AMPLITUDETYPE, so it is also called A ultrasonic diagnostic instrument. The other is through the light spot to respond, the brightness of the light spot, echo is strong, but vice versa. This type is also called light spot display, and the English word is BRIHGTNESSTYPE. Therefore, also known as B ultrasonic diagnostic instrument, is currently widely used. 2 、 ultrasonic diagnosis of liver diseases (1) the position of preparation and examination before examination; Check the diet a day before eating greasy food, and fasting 8 hours. Position: take supine position for deep inspiration. In order to enlarge the range of observation, it is necessary to change the position of the body properly, such as left lateral decubitus or right lateral decubitus. (2) normal sonogram The shape and size of the upper abdomen were longitudinal, the liver was triangular, the diaphragm was obtuse and the lower margin was acute. The left lobe was less than 45 and the right lobe was less than 75. The outline of the normal liver is clear, smooth and smooth. The thickness of the right liver lobe is less than 14CM, and the left leaf thickness is less than 6CM. Intrahepatic structure: the intrahepatic luminal structure and ligament, called the texture of the liver. When normal, the intra hepatic spinning is clear and homogeneous, the diameter of the portal vein (PV) is less than 1.4CM, and the diameter of the common bile duct (CBD) is less than 0.6CM. Intrahepatic echo features: normal liver parenchyma is medium or weak echo light spot, and its intensity and frequency are even. General echo of liver parenchyma than renal parenchyma and a slightly weaker pancreas or similar. (3) pathological sonogram Hepatic cyst In the liver, it is round or oval, anechoic dark area. The wall of the capsule is thin, the outline is smooth and smooth, and the boundary of the surrounding tissue is clear. The echo of the posterior wall is obviously enhanced. Polycystic liver The liver is diffusely enlarged and the surface is irregular. There are various fluid cystic cavities in the liver, and the echogenicity of the hepatic parenchyma is enhanced. Polycystic kidney disease. Liver abscess Lack of expertise and local damage echoless liver parenchyma, followed by echoenhance. It can be single or multiple. The boundary between the lesion and the surrounding tissue is unclear, the edge is often irregular and the rule is out of order. Sometimes around the abscess there are several millimeters wide annular hypoechoic areas representing inflammatory areas. Hepatic hemangioma Approximately 70% are solitary, with the right lobe of the liver most common and located at the periphery of the liver. The tumor has an envelope, so it is clearly demarcated from the surrounding normal liver tissue. The sonographic findings for rounded contours, strong echo, boundary and liver parenchyma is very clear. About 1/10 is weak echo. But the envelope remains clear. Primary liver cancer The sonogram can be divided into three types: Block type: for the performance of the lesions of huge liver, mostly round, oval or lobulated, irregular borders, the edge of a weak echo band, also known as the weak echo halo, blurred boundary. The lump shows strong echo or weak echo, coarse or uneven, or the echo area is mixed, and the center can be necrosis and liquefied area. Sometimes a block is visible. Enlargement or abnormal shape. Nodular type: there are many round or oval occupying lesions in the liver. The diameter of the lesions is more than 2 to 3CM, and the outline is regular. There is a faint echo halo of 1 to several millimeters wide, which is distinct from the liver parenchyma. Diffuse type: rare liver deformation surrounding the nodules in the normal liver, strong echo and visible sorting chaos, clusters of diffuse and uneven distribution in the liver, it can not distinguish the mass boundary. Metastatic liver cancer Sonographic features: multiple round masses in the liver, the size of which is not related. The tumor and liver tissue around the clear boundary and surrounding the weak echo halo, also known as the "bull eye sign". Most of them appear to be highly specialized and a few can be weak or moderately echo. The transfer of tumor necrosis, central fluid cavity. The liver of metastatic liver cancer is rarely associated with cirrhosis. Liver enlargement, abnormal shape, can also be partial swelling. The normal structure of liver is not clear and chaotic. Cirrhosis Sonographic features: The size and shape of the liver: the liver becomes smaller and the edges are jagged. Liver: liver structure pattern of intrahepatic tubular structure Sorting chaos, significantly reduced. Hepatic echo enhanced and thickened. Portal vein dilatation. Splenomegaly The liver wall is thickened and may be a double - layered structure, also called bilateral sign. Ascites can occur. Fatty liver Sonographic features: generalized enlargement of the liver. Echo enhanced hepatic parenchyma. Sound attenuation is evident and deep hepatic parenchyma is often absent. Intrahepatic vascular insufficiency. The gallbladder opening is unclear. Congestion liver Sonographic features: the liver is generally enlarged, and the hepatic parenchyma is essentially normal in echo intensity and structure. The width of hepatic vein is larger than 1.0CM. 3 、 ultrasonographic diagnosis of biliary tract diseases (1) preparation and checking position before examination; Preparation before examination: the patient must be kept off food for more than 24 hours to ensure that the gall bladder and bile duct are filled with bile and to reduce the influence of the contents and gases of the gastrointestinal tract. Usually on the previous day after dinner began fasting, the next morning fasting examination is appropriate. X - ray gastrointestinal and cholangiography: if there is barium in the gastrointestinal tract near the gallbladder and bile duct, it will affect the ultrasonic examination. Therefore the first general arrangement ultrasonography, or within three days after the X-ray angiography, angiography two days after gallbladder ultrasonography. Check position: supine position: is the most commonly used position. Right anterior oblique: body and bed surface from 39 degrees to 45 degrees. (2) normal sonogram gallbladder The longitudinal section is pear shaped and may be round or long. The shape of the normal gallbladder is smooth and tidy, and the curve is clear and definite. There is no echo in the gallbladder cavity. The posterior wall is bright and the echo below the posterior wall is enhanced. The normal size of the gallbladder is 8 x 3.5CM and the wall thickness is less than 2 to 3MM. Intrahepatic bile duct Normal, you can see the left and right hepatic duct, diameter below 2MM. The intrahepatic bile duct branches are not clear at grade two or more. Extrahepatic bile duct Normal, the upper extrahepatic bile duct can be seen, the diameter should be smaller than the corresponding portal vein 1/3, the diameter of less than 0.6CM. (3) pathological acoustic image: Gallstone Ultrasonographic features: hyperechoic masses appear in the gallbladder cavity. Because the shape and size of the stones are different, the hyperechoic group can be mass or speckled. The scattered spherical stones are crescent or semicircular. Stones and more hours, then accumulate in the back wall of the gallbladder, forming a strong vocal fold, it is difficult to distinguish between stones. The strong echogenic masses of gallbladder stones are clearly defined and clear. Sound shadow: because the ultrasound beam meets the stone, the interface is completely reflected, so there is a no echo area behind the strong echo of the stone, also called "sound shadow". The appearance of acoustic image is of great value for the diagnosis of stones, especially for small stones. When changing positions, the echo group moves in the direction of gravity. This is important for the distinction between stones and gallbladder tumors. Extrahepatic bile duct stone Sonographic features: bile duct dilatation with stones, thickening of the wall and strong echo. A hyperechoic mass can be seen in the bile duct cavity. There is a division between the echogenic mass and the bile duct wall. There is a shadow behind the hyperechoic mass. Intrahepatic bile duct stone Sonographic features: strong echogenic masses can be seen in the liver, and their morphology and size are different, which can be irregular, patchy, round or irregular border symptoms. Usually with sound shadow. Distal bile duct dilatation with stone obstruction. acute cholecystitis Sonographic features: enlargement of the gallbladder, blurred outline. The thickening of the gallbladder is a strong vocal fold, with intermittent or continuous weak vocal folds, resulting in bilateral manifestations of the gallbladder. Large echo spots were found in the gallbladder, which were uneven and silent. Gallbladder stones often associated with. There is a fluid dark area around the gallbladder, and the gallbladder contraction function is weakened. chronic cholecystitis Ultrasonographic features: the gallbladder shrinks and the cystic cavity becomes smaller. Cystic wall thickening, unsmooth and echogenic. Poor gallbladder contraction function. Often accompanied by gallstones. gallbladder polyps Sonographic features: there are a few small circular echogenic masses in the wall of the gallbladder, which penetrate into the gallbladder cavity. The boundary is clear, smooth and silent, and does not move with the change of body position. Gallbladder carcinoma The sonogram can be divided into five groups: Block type. The normal fluid type of the inferior vena cava disappeared and manifested as a weak echo or echo of a solid mass of uneven mass. The thick walled cyst wall is unevenly thickened and tends to be more prominent in the neck and body region. An umbrella shaped mass characterized by weak echoes or moderately strong echoes. The umbrella shaped masses of the gall bladder go into the gall bladder cavity, often with multiple bases, wide margins and irregular margins. Silent shadows do not move with all movements of the body. The mixed type is often a mixture of thick walled and mushroom umbrella types. Obstructive lesions are usually not large and are weak echo or medium intensity echo masses, which are blocked at the neck of the gallbladder and cause hydronephrosis. 4 、 ultrasonographic diagnosis of pancreatic diseases (1) preparation and checking position before examination; Inspection preparation Should be fasting for more than 8 hours, especially in the morning after breakfast is forbidden to check as well. Gastrointestinal gas too much, in the three days before the examination day before the oral dimethicone, into a small residue diet before bedtime, laxative. Inspection can be 500 to 1000CC drinking water, in order to observe. The position of the patient: usually supine or semi supine with 30 to 45 corners of the upper body and the bed surface. (2) normal sound image There are three types of normal pancreas in normal people: The shape of the head and neck of sausage type is similar to that of body tail. Dumbbell shaped neck with thick head and tail thickening. The thickness of the pancreatic head of tadpole normal people is less than 2.5CM, and the thickness of the body tail is less than 2CM. The normal pancreas internal echo uniform, fine and dense, slightly less than the surrounding tissue or similar, generally increases with age echoenhance. Normal human pancreatic duct ultrasound measured near the head up to 3MM, body general 2MM (3) pathological sonogram acute pancreatitis The pancreas is generally enlarged, and the outline of the pancreas is curved and the border is blurred. The pancreas is weak echo or echo free area, and its posterior echo is enhanced. There is a effusion around the pancreas. Chronic pancreatitis: Partial or generalized enlargement of the pancreas, or a small amount of it, can also be narrowed. The boundary of pancreas and surrounding tissue is not clear, the outline is irregular, irregular and can be projected locally. The internal echo of pancreas is mostly enhanced, with coarse spots and uneven distribution. Pancreatic duct can be cystic dilatation, thickening or uneven thickness. pancreatic cancer Pancreatic morphological changes: enlargement of the pancreas, enlargement of the pancreas and irregular enlargement of the whole pancreas. Most of the pancreatic cancer masses are irregular in shape and unclear in boundary. Most of the masses are weak echo, scattered in strong echo spot. The minority is medium or strong echo with uneven distribution. The necrosis, hemorrhage and liquefaction of the tumor are complicated images of dark area and strong echo spot. Indirect manifestation: when the lower end of the common bile duct is compressed, it can cause dilatation of the common bile duct, enlargement of the gallbladder and dilatation of the pancreatic duct. Compression of the portal vein can cause dilation of the portal vein, the superior mesenteric vein and the splenic vein. The inferior vena cava can also be compressed and narrowed. 5. Ultrasonography of spleen (1) normal sonogram The diaphragm is arc-shaped structure of spleen, smooth and neat, dirty face slightly concave, visible splenic notch, strong echo. The echo of spleen parenchyma is very homogeneous, and the echo intensity is slightly below or near the liver, which is slightly higher than that of the renal cortex. The normal thickness of spleen is less than 4CM. (2) ultrasonographic findings of splenomegaly One of the following conditions for splenomegaly. The thickness of spleen in male and female was over 4CM and 3.8CM, and the lower margin of spleen was more than that of costal line. The length is more than 8CM. The diameter of the upper and lower spleen is greater than 10.5CM. 6. Ultrasonography of the kidney (1) normal sonogram Normal, with a bright outline of the kidney. The renal cortex is hypoechoic, with only a small amount of light scattered over the spot. The pyramidal area of the kidney is triangular, with less internal echoes, and is arranged radially around the collection system. It can be seen that 3 to 5 or 7 to 8 do not wait. The central part of the kidney is a collection of systemic echoes, characterized by dense bright spots, echoes of the renal pelvis, and echoes of fat in the renal sinus. Normal, the collection of light spots accounted for kidney width of 1/2 to 2/3. (2) pathological acoustic image Hydronephrosis Sonogram features: the main change is the separation of light from the central collective system, and there is no echo dark area in the center. The width is above 8MM. In moderate hydronephrosis, the renal pelvis has no echo area and is oval, elongated, or rhomboid. Giant hydronephrosis, only large dark areas with separated light, thinner renal parenchyma. renal cyst Sonographic features: clear, rounded, non echogenic areas in the kidney. The edges are clear, smooth and tidy. Posterior echo enhancement of cystic wall. Cysts can be solitary or multiple. Polycystic kidney Ultrasonographic features: the renal appearance is generally enlarged, and there are many circular non echo areas in the kidney. The size is not waiting until the edge is regular. Renal tumor Hamartoma is a benign tumor. The image of many wind distribution of the strong echo, clear boundary. The ultrasonographic features of renal cell carcinoma are usually homogeneous and dark, in which small scattered spots can be seen and distributed evenly. The margin of the tumor is not as clear as the cyst, and the internal echo is stronger than the normal renal parenchyma. Sometimes there is an uneven dark zone in the parenchyma of the kidney, which is caused by bleeding. Renal calculus Stones with a diameter of 0.5CM or more appear hyperechoic or light spots, followed by acoustic shadows. Kidney stones are often associated with hydronephrosis. 7. Ultrasonography of the bladder (1) pre examination preparation; Drink plenty of water before checking, Urinary bladder filling, mucous membrane extension, easy to detect lesions. (2) normal sonogram Normal bladder, bladder cross-sections were round or oval, longitudinal slightly triangular, rearward protrusion of the posterior wall of bladder. Because of the presence of the uterus behind the female bladder, the bladder is slightly depressed. The walls of the normal bladder are smooth, complete and tidy. (3) pathological sonogram Bladder tumor Papillary urothelial carcinoma is the most common type of bladder tumor, accounting for 90%. Ultrasonographic features: the sonogram of the bladder tumor shows bright spots and clusters in the tumor, and the sound is better. It is usually located in the deep shadow of the tumor. The staging of bladder tumor is mainly to observe the continuity and integrity of the bladder wall of the tumor attachment. When the tumor invades the muscularis. Light scattered irregular bladder wall. The tumors of seaweed, cauliflower and pedicel were usually of low stage, and the stage of papillary and basal tumors was higher. Bladder stone Sonographic features: the presence of hyperechoic light in the bladder cavity is accompanied by acoustic shadows, and stone activity can be seen in the change of posture. Vesical diverticulum Sonographic characteristics: another cystic dark area is seen on the side, back or top of the bladder. The surface is smooth and shrinks or disappears after urination. 8, prostate ultrasound examination (1) normal sonogram The normal prostate is about 4 x 3 x 2CM in size. The cross section is chestnut shaped symmetrical; the longitudinal section is oval, large small. The anterior gland flap is a smooth continuous line, and the glands are uniformly scattered. A bright spot from the urethra is visible in the image center. (2) the sonogram of the disease Hypertrophy of prostate The sonogram showed only enlargement of the prostate gland. prostatic cancer On the sonogram, the prostate enlarged and the internal light spots were unevenly distributed, and irregular bright spots or clusters of light appeared. The envelope lines were not continuous. chronic prostatitis On sonography, the shape of the prostate is not enlarged, but irregular bright spots are seen. 9, gynecological ultrasound examination (1) pre examination preparation; Check before drinking plenty of water, do not urinate, so that the bladder is fully filled, so as to well display the uterus and accessories. (2) normal sonogram of uterus and accessory The longitudinal section of the uterus is located behind the bladder. The uterus is slightly flattened, inverted pear like, with a tapered tip. The uterus is a substantial homogeneous structure with smooth contours, uniform fine spots and sometimes a strong reflection of the lumen of the uterus. Adult women with uterine size was 7 ~ 8CM, width of 4 ~ 5CM, 2 ~ 3CM palace wall thickness. Below the uterus can be seen from 2.5 to 3CM of the cervix. The normal ovary is about 2.5 x 2 x 1CM in size and is a substantial image with internal echoes of faint, uniformly fine spots. (3) pathological sonogram Fibroid In the sonogram, the uterus is enlarged and there is a uniform, small, scattered hypoechoic mass in the muscle wall, which is clearly demarcated from the normal myometrium. There are three kinds of myoma: serosa, intramural and submucous. Carcinoma of corpus uteri On sonography, the uterus is enlarged in size, showing a solid, heterogeneous, and unevenly distributed mass. When the tumor is necrotic and bleeding, there is an echo area in the lesion. There is no capsule in the corpus uteri, so it is not clear with the surrounding normal tissue. Chorionic epithelioma On sonography, the uterus is enlarged, irregularly shaped, outward nodular, and hypoechoic. Irregular light spots appear in the uterus. There is also a fluid dark area of bilateral ovarian lutein cysts. When the tumor has necrosis and bleeding, it forms a scattered and dark area in the uterus. Oophoritic cyst The sonogram shows a circular or oval anechoic dark area with thin, smooth, clear walls. Serous cystadenocarcinoma of ovary The cystic anechoic area showed scattered light spot, and the papillary wall of cyst wall was obvious. Mucinous cystadenoma of ovary An oval liquid dark area can be seen on the sonogram. The volume is large and the scattered spots can be scattered. Often a unilateral multilocular structure with a smooth and thick cystic wall and a thin long thin band with varying size. Mucinous cystadenocarcinoma of ovary There were many cysts in the sonogram and the band of the capsule was thickened, but the interface was not clear in the dark region. When the cancer bleeding and necrosis, the capsule is bloody, so in the dark area there is scattered spots, often ascites. Benign parenchymal tumor of ovary On the sonogram, the outline is clear and the scattered, uniform and tiny spots are visible inside. Malignant parenchymal tumor of ovary On the sonogram, the contours and edges are irregular, the thickness of the wall is different, and the internal echo intensity is different, and the spots and clusters are irregular and scattered. When the tumor is bleeding and necrotic, the anechoic area is formed locally. 10 、 obstetric ultrasound examination (1) normal pregnancy Ultrasonography of early pregnancy A circular or elliptical halo is seen in the uterus, with anechoic dark areas. This is the echo of the amniotic sac. The gestational sac first appeared at fifth weeks of gestation, in which the sprouts of the spot were germ. At the end of the sixth week, there is rhythmic pulsation in the embryo of the capsule, which is the beat of the primitive heart tube. At twelfth weeks the amniotic sac is filled with all the uterine cavities. Early placenta banyuexing spot, attached to the side wall of the gestational sac. Sonogram of mid trimester pregnancy At 12 weeks of gestation, the head of the fetus presents a round halo. After 12 weeks, the head of the fetus is round, and the middle part of the halo shows a strip of light, which is the echo of the midline of the brain. The two light bands are symmetrical on the lateral side of the midline light band, which is the echo of the lateral ventricles. Later, the fetal trunk shows gradually, such as the spine, chest, abdomen and limbs. Late pregnancy sonogram The area of the amniotic fluid is relatively narrow, and the structures of the fetal parts are clearer. From one side of the outer halo of fetal head and brain midline vertical to the other side of the outer edge of the length measurement called biparietal diameter (BPD), fetal biparietal diameter with gestational weeks increased, yield up to 9.5CM. (2) sonogram of obstetric diseases Ectopic pregnancy Sonographic features: the uterus is slightly enlarged without pregnancy sacs. The pelvic area can be found with blurred and irregular bands of light, which are close to the edge of the uterus or the base of the uterus and rectum fossa. The size is about 3 to 8MM. Dark areas are seen when accompanied by intraperitoneal hemorrhage. Placenta previa Sonographic features: Central type: the placenta spot is located in the anterior and posterior walls below the isthmus of the uterus, and the mouth of the uterus is covered by placenta. Placental echo covering part of the mouth of the uterus. Edge: edge part just uteroplacental inside the mouth. Low placenta: the marginal part of the placenta that has not reached the mouth of the uterus but is very close. Placental abruption There was no echo area between the echo of the placenta and the echo of the uterus wall. Amniotic fluid excess On the sonogram, the uterus was larger than the actual gestational weeks, and the width of the dark zone increased, and the maximum width was more than 10CM. The width of normal amniotic fluid is 4 to 6CM.