Carrying out duplex scanning of the vessels of the abdominal aorta and its branches. How to do an ultrasound of the abdominal vessels: preparation, indications, results, cost Make an ultrasound of the abdominal vessels

Ultrasound Dopplerography (Doppler ultrasound) of abdominal vessels is a modern type of comprehensive diagnostics of internal organs using ultrasound, which is based on the Doppler effect. The duplex scanning technique is used to determine the objective state of the vascular system and simultaneously assess the condition of soft tissues. Dopplerography of the abdominal aorta is recognized as the fastest, most informative and painless way to check the state of the blood supply. Using this examination, you can identify the nature of blood flow in the blood vessels of the abdominal cavity of any size.

Ultrasound screening of abdominal vessels is a non-invasive, safe and highly effective diagnostic tool. Since the body is not exposed to radiation during the examination, ultrasound scanning has no absolute contraindications or limitations. According to indications, abdominal ultrasound can be performed on children at any age.

Indications

Doppler ultrasound of the abdominal vessels allows one to reliably determine the following data: blood flow velocity; destructive changes in blood vessels due to inflammatory or atherosclerotic processes; anomalies, including obstruction and pathological tortuosity, of vessels of a congenital or acquired nature. This diagnostic makes it possible to diagnose pathologies of the abdominal vessels, dysfunction of the liver, kidneys, and pancreas in the early stages. Dopplerography reveals: atherosclerosis, abdominal aortic aneurysm, celiac stenosis, occlusion.

Preparation

You should prepare for an ultrasound examination of abdominal vessels: during the day, do not consume foods that contribute to excessive gas formation in the intestines and, on the recommendation of a doctor, take activated charcoal (4-5 tablets 3 times a day). The study is carried out on an empty stomach. The patient takes a comfortable position on the couch and provides the doctor with access to the area where the diagnosis will be performed. As a rule, the examination lasts 30-40 minutes.

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Price

The cost of a UZD of abdominal vessels in Moscow ranges from 1800 to 9600 rubles. The average price is 3860 rubles.

Where to do an ultrasound scan of abdominal vessels?

Our portal contains all the clinics where you can have an ultrasound scan of abdominal vessels in Moscow. Choose a clinic that suits your price and location and make an appointment on our website or by phone.

If damage to the aorta and its branches is suspected, an ultrasound scan is performed in duplex scanning mode. It combines ultrasound and Doppler examination of blood flow. Using this method, aneurysms, their dissection, abnormalities in the structure of blood vessels, external compression, and atherosclerotic changes are detected. Before scanning the abdominal aorta, preparation is needed to prevent flatulence.

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Indications for duplex scanning of the abdominal region

• constant or paroxysmal, intense abdominal pain for an unknown reason, a feeling of pulsation;
• listening to a systolic murmur during examination;
• sustainable;
• nephrotic syndrome;
• alternating diarrhea and constipation;
• weight loss;
• indigestion - belching, nausea, flatulence, bitterness in the mouth, vomiting.

Advantages and disadvantages of the method

Duplex scanning is a safe diagnostic method that has no contraindications for use and does not cause consequences even with repeated use. It does not require the administration of a contrast agent, which causes allergic reactions, and there is no risk of radiation exposure. It is important that the study is only external, which distinguishes it from.

On average, the entire procedure lasts no more than 15 - 20 minutes, and after it you can immediately return to your normal activities. Ultrasound machines are available not only to large clinics, but also to outpatient clinics. This examination of blood vessels allows:

• estimate their size;
• wall structure;
• presence of obstructions to blood flow;
• see blood movement in real time;
• measure the speed of the pulse wave and its propagation;
• flow properties and linearity.

Duplex scanning of the abdominal cavity

The disadvantages of the technique include its subjectivity, since the data obtained and the degree of their reliability in most cases are determined by the qualifications and experience of the specialist, and the technical capabilities of the device. With duplex scanning, vessels of large and medium diameter can be seen quite clearly, and angiography is required to study smaller branches or before surgery.

What can be determined when diagnosing the abdominal aorta and its branches, arch

Diagnosis of the aortic arch can determine the presence of atherosclerosis, aneurysmal dilatation, thrombotic masses in the aneurysm sac, and signs of its dissection. Using duplex scanning, you can diagnose coarctation, a congenital malformation in which there is a local narrowing of the aorta or its complete fusion.

In the presence of an inflammatory process (aortitis) in the thoracic region, ultrasound with Dopplerography helps to assess its prevalence and complications in the form of scar changes or calcification of the walls.

Duplex scanning of the abdominal aorta reveals diseases, many of which are an indication for immediate surgery, since they threaten not only the health, but also the life of the patient.

Atherosclerosis

Leads to insufficient nutrition of organs by arteries due to narrowing of their lumen. Depending on the branch that is affected, it occurs in the kidneys, pancreas, stomach, liver, adrenal glands. This is manifested by pain and disruption of the functioning of organs, the digestive system as a whole, the regulation of blood pressure and urine excretion.

Preparing to Scan

The basic rule for conducting a high-quality ultrasound examination of the vessels of the abdominal cavity is to empty the intestines of contents and prevent excess gas formation.

If the patient has signs of flatulence, then 5 days before the examination it is necessary to exclude legumes (peas, beans, lentils), peanuts, cabbage, fresh bread, fruits, and milk from the diet. The doctor may also prescribe medications to reduce gases in the intestines - Espumisan, Enterospasmil, tea with fennel or dill.

If you are prone to constipation, it is recommended to cleanse the large intestine using osmotic laxatives - Fortrans, Diagnol. The evening before the procedure, dinner should be light and breakfast should be avoided. You can drink some clean water without gas in the morning.

Watch the video on how to prepare for an abdominal ultrasound:

Research methodology

Duplex scanning technology is no different from standard ultrasound. The patient is positioned on the couch, a contact gel is applied to the anterior abdominal wall, then the emitter of the device is moved across the abdomen. When scanning the vessels, their image appears on the doctor’s monitor. He records the resulting image and, using software, takes the necessary measurements of the diameter of the vessels and the speed of blood movement.

Condition assessment criteria

Normally, the diameter of the aorta in the abdominal region is about 3 cm, and its branches reach from 0.7 to 1.5 cm with good patency. The direction of blood movement should be linear, the wall of the artery is smooth, its contour is clear. The lumen of the vessel is not visible in a healthy person.

Determining the maximum (peak) blood velocity is important. The patient’s age is taken into account, since vascular tone, the state of the cardiovascular system as a whole, as well as the ratio of blood flow velocities in the arteries and aorta depend on it.

With an aneurysm, ultrasound detects a bulge, a thin wall, an increase in diameter, a reduced speed of blood flow at the site of the sac, and blood clots. In the case of thrombosis, in the lumen of the artery or aorta there is a hyperechoic (dense) formation with unclear contours, which prevents the uniform movement of blood.

Atherosclerosis manifests itself:

• hyperechoic plaque on the wall, heterogeneous in structure;
• in the center of the atheromatous masses there are inclusions of calcium;
• the volumetric velocity of blood movement is reduced, the linear velocity is increased.

Stenosis of the celiac trunk does not occur very often. It may be congenital or acquired. Symptoms can be confused with gastrointestinal problems. Treatment for compression stenosis involves surgery on the aorta. Nutrition after should be limited.

If lameness and pain while walking suddenly appear, then these signs may indicate obliterating atherosclerosis of the vessels of the lower extremities. In an advanced state of the disease, which progresses to stage 4, amputation surgery may be required. What are the possible treatment options?

As a result of atherosclerosis and other diseases, carotid artery stenosis can occur. It can be critical and hemodynamically significant, and have different degrees. Symptoms will prompt treatment options, including when surgery is needed. What is the prognosis for life?

An ultrasound of the brachiocephalic arteries is performed based on patient complaints related to blood circulation in the brain, dizziness, and others. Ultrasound standards, as well as deviations during duplex scanning, will confirm or refute the diagnosis.

An examination such as a duplex scan of the head and neck is carried out both for indications and for prevention. Transcranial scanning of the veins and vessels of the neck, arteries of the head, brain, and brachiocephalic vessels can be performed. How is it going?

Ultrasound examination of abdominal vessels is indicated for suspected diseases of organs located in the pelvis, peritoneum, and even the chest. Sometimes diagnostics are prescribed if pathologies of the circulatory and nervous systems are suspected. This procedure is non-invasive and easily tolerated by patients, but requires some preparation to be effective.

Types of ultrasound of the abdominal aorta and its branches

Vascular ultrasound is a procedure in which sound waves impact moving elements, resulting in amplification. Vascular ultrasound is called Dopplerography in honor of the scientist who discovered this method. Ultrasound examination is more informative than ultrasound; it is also intended for studying the lymphatic system. There are several types:

• Ultrasound Doppler. The primary method for studying the blood vessels of the body, which allows you to determine the patency of the circulatory system by the nature of the blood flow. The method gives a general idea of ​​the state of the system, but does not provide accurate information about the disturbance in certain parts of the veins and arteries.
• Ultrasound scanning, or duplex scanning. Precise research that resulted from an improvement on previous technology. Allows you to identify the location of the disorder in the vessel, gives an idea of ​​the width of its lumen and contours. Using ultrasound, atherosclerosis, inflammation, abdominal aortic aneurysms, blood clots are detected, and the blood flow speed is determined.
• Triplex scanning. Color duplex mapping is an even more modern technique than ultrasound. With its help, you can study all the parameters of blood vessels, as well as obtain a color image of red arteries and blue veins.

Modern models of devices designed for ultrasound are capable of performing any type of examination. During diagnostics, you can always switch to the additional mode.

Separately, the ultrasound technique with contrast should be highlighted. Diagnostics are carried out with the Sonovue substance, which contains small air bubbles. The drug is administered some time before the examination. It improves the contours of blood vessels and is often used to diagnose visceral capillaries of the peritoneum.

Indications for vascular scanning

The procedure allows you to get a complete picture of the problem

Ultrasound of the abdominal aorta is prescribed when pain of an unknown nature appears, concentrated in the abdomen and radiating to the lumbar region. The symptoms can be compared to renal colic, which are severe. The pain is mainly located on the left and near the navel, sometimes radiating to the groin and lower extremities.

There are other indications for studying the peritoneal vessels:

• constant headaches and dizziness, pulsation of the temples and the back of the head, the appearance of spots in the eyes;
• persistent low or high blood pressure;
• ischemia, stroke, hypertensive crisis, as well as abdominal injuries;
  
• old age – from 60 years;
• long-term smoking;
• memory problems;
• epilepsy;
• atherosclerosis and high cholesterol;
• diabetes mellitus;
• chronic hepatitis and other liver diseases;
• systematic constipation, symptoms of colitis;
• pulsation in the abdominal area;
• swelling of the lower extremities.

There are no absolute contraindications. Among the relative ones there are: skin injuries in the area of ​​examination, as well as diseases with open ulcers and abrasions. The patient's serious condition and fever can also become a temporary refusal to perform vascular ultrasound.

Preparing for diagnosis



An ultrasound scan of the abdominal aorta and its branches shows a reliable result only if the patient has properly prepared for the procedure. In general, preparation does not take much time or effort and does not require a radical lifestyle change. However, the patient must remember that its main goal is to cleanse the gastrointestinal tract of accumulated waste products and gases.

Begin preparation 3 days before the ultrasound, be sure to follow a gentle diet: eliminate foods that cause gas formation. You need to eat in small portions, without overeating, and without eating at night. Here's what you need to give up:

• fresh black and white bread, pastries, muffins;
• raw fruits and vegetables, especially apples and cabbage;
• legumes – beans, peas, lentils;
• carbonated drinks;
• fatty cheeses, meat, fish;
• any fried foods.

The basis of the diet is baked vegetables, white and lean meat, and fish. You can eat fermented milk products in small quantities. Drinking alcohol and smoking are strictly prohibited.

The day before the diagnosis, take Espumisan: 2 capsules in the morning, lunch and evening, as well as 2 tablets on the day of the procedure. Some patients are recommended to drink the emulsion, then the dosage is 10 ml.

In the evening before the ultrasound, take a weak laxative if there has been no bowel movement. If bowel movement does not occur in the morning, give 2-3 Microlax microenemas 30-40 minutes before the procedure. You cannot eat 6-8 hours before the diagnosis. The drinking regime is selected individually. Typically, patients are not recommended to drink 3-4 hours before the examination.

Ultrasound technique



Ultrasound of the abdominal aorta is a painless and safe procedure

The technology for performing vascular ultrasound is not much different from diagnosing internal organs. This is a non-invasive procedure that does not cause any discomfort to people. The only unpleasant sensation that may occur is cold when the gel comes into contact with the skin.

1. The patient takes off his outer clothing, lies down on the couch and lifts his T-shirt, blouse or shirt.
2. The doctor lubricates the ultrasound probe with gel and places it on the patient's abdomen.
3. They are carried out in different directions, studying the internal state.
4. From time to time the patient is asked to turn on his side, breathe or hold his breath.

The sensor picks up the reflected waves and displays them on the monitor. During the procedure, the doctor records the diagnosis on video. After 15-30 minutes, the results are on a disk or flash drive and transferred to the patient.

The diagnostic procedure with or without contrast agent takes from 15 to 40 minutes. With any of the described methods, the doctor performs the same actions, using different operating modes of the device.

Data decryption

Ultrasound provides full-scale visualization of the abdominal aorta, as well as its branches. Examination of the peritoneum shows the condition of the vessels of the spleen, liver, kidneys, iliac veins and arteries, and elements of the pancreas. The portal vein, which supplies blood to the abdominal and pelvic organs, as well as the inferior vena cava, are also examined.

Normally, the vessels have a certain lumen width, a smooth structure without damage. There are no blood clots, plaques, pathological expansions, compactions or thinning in the lumen.

During an ultrasound, the doctor evaluates the nature of blood flow: the speed of its inflow and outflow, the uniformity of movement. After the procedure, you can get a preliminary diagnosis:

• stenosis (narrowing) of blood vessels;
• compression by external elements, for example, a tumor;
• insufficient blood supply to organs;
• the presence of atherosclerotic plaques and blood clots;
• problems with the outflow of blood in the portal vein, which is observed with hepatitis and cirrhosis;
• thinning of the wall of a vessel or aorta with saccular expansion (aneurysm).

If the patient has undergone vascular surgery, Doppler sonography will show their condition.

Advantages and disadvantages of ultrasound

Ultrasound examination of blood vessels is one of the most modern and informative methods for studying the condition of the organs and circulatory system of the abdominal cavity. The cost of the procedure is much lower than CT or MRI, and it can be performed regularly without fear for health. There are other advantages:

• complete absence of discomfort and pain;
• ultrasound is 100% safe, and ionizing radiation can be harmful;
• diagnostics are carried out in real time, showing the current picture;
• no invasive intervention required: punctures, incisions;
• you can study the circulatory system from all sides, obtain a contrast and color image;
• information is instantly recorded on digital media and can be printed;
• In parallel, a biopsy can be performed if required.

However, this method is not without some disadvantages. Some vessels and branches of the aorta are located so deep in the organs that projection layering occurs. They cannot be seen during an ultrasound. The spatial resolution of ultrasound is much less than that of MRI or CT. If you are overweight, it is impossible to perform an ultrasound; CT and MRI make it possible to obtain reliable information even in patients weighing up to 150 kg.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Ultrasound of the gastrointestinal tract ( Gastrointestinal tract). Diseases of the stomach and intestines on ultrasound. Ultrasound diagnosis of appendicitis

Abdominal ultrasound It is used, as a rule, to study parenchymal organs - liver, pancreas, spleen. The stomach and intestines are hollow organs of large total extent, in which food is digested and nutrients are absorbed from it. They are distinguished by a large total area of ​​the walls and do not have parenchyma, which is why difficulties arise during their ultrasound examination. The fullness of the gastrointestinal tract with air and intestinal gases also prevents their study Ultrasound.

The gastrointestinal tract, due to its anatomical features, is not an ideal object for ultrasound examination.
Despite this, when examining the abdominal organs, the stomach and intestines are sometimes examined. Using ultrasound, you can detect functional disorders, some inflammatory diseases and tumors, accompanied by thickening of the walls of the stomach and intestines.

The disadvantage of ultrasound examination of the gastrointestinal tract is that the wall of the stomach and intestines is presented in a plane, which is why ulcers, vascular disorders, and small polyps can be missed. To visualize these formations on ultrasound, very high-resolution equipment and a very thorough examination are required. Therefore, to examine the stomach and intestines, fibrogastroduodenoscopy is often performed ( FGDS), in which the wall of the stomach and intestines is examined using a special camera.

Ultrasound of the stomach and intestines with water-siphon test ( water load)

Ultrasound is not the best method for examining the gastrointestinal tract. Using ultrasound, you can evaluate the shape of the stomach and intestines, the thickness of the walls, and the presence of changes in their walls. For examination of the stomach and intestines using ultrasound, it is especially important to follow a three-day diet that reduces gas formation. However, a special technique is also used to study the gastrointestinal tract. It involves the use of water load, that is, the use of volumes of liquids.

First, a routine ultrasound examination of the hollow organs of the gastrointestinal tract is performed. After this, the patient drinks 1 liter of water or light apple juice. A repeat ultrasound is performed immediately after the stomach is filled. Using this test, the doctor evaluates the motor function of the stomach, peristalsis, and the condition of the valves separating different parts of the gastrointestinal tract. Using a water-siphon test, you can assess in more detail the condition of the intestinal wall and the rate of fluid absorption in the intestine. Typically, 250 ml of liquid is completely absorbed in 20 minutes or less, with the liquid leaving the stomach in 3 to 5 minutes.

Thus, to study the stomach and intestines, a special water loading technique is more often used, which allows one to obtain additional information about the state of the gastrointestinal tract.

Visualization of the gastrointestinal tract by ultrasound

The stomach is located between the esophagus and duodenum. The volume of an empty stomach is about 0.7 liters. Its dimensions vary significantly depending on the size and build of the person. The stomach is located in the upper abdominal cavity, bordered by the liver, spleen, pancreas and small intestine. It is divided into the fundus, body, cardiac and pyloric sections. The cardiac section is located at the esophagus, and the pyloric section is at the junction with the duodenum. The stomach is separated from the esophagus and small intestine by sphincters - muscle valves that regulate the movement of the food bolus through the gastrointestinal tract.

An abdominal ultrasound can examine the wall of all parts of the stomach. The thickness of the gastric wall ranges from 5 mm in the cardiac region to 7 mm in the pyloric region. There are 5 layers in the wall of the stomach, of which the innermost and outermost are more echogenic compared to those enclosed between them. Ultrasound of the stomach evaluates the uniformity of the thickness of the layers over the entire length of the wall.

Using ultrasound, the following layers of the stomach wall can be distinguished:

• Outer serous membrane. It is up to 1 mm thick and hyperechoic.
• Muscle layer. It has a thickness of 2 - 3 mm and is characterized by lower echogenicity.
• Submucosal layer. It is connective tissue. It is 3 mm thick and has an average degree of echogenicity.
• Muscular plate of the mucous membrane. It has a thickness of up to 1 mm and is hypoechoic.
• The actual mucous membrane of the stomach. Hyperechoic, has a small thickness, about 1 mm.

The small intestine is divided into several sections, having a total length of about 8 meters. Due to the overlap of intestinal loops on each other, they are almost impossible to examine using ultrasound, since they are indistinguishable. Only the initial section of the small intestine, the duodenum, can be examined by ultrasound due to its proximity to the stomach.

The large intestine can be traced along its entire length, in most cases haustrae and folds can be identified. Haustra are protrusions of the wall of the large intestine formed by the muscle layer. The ultrasound also shows the appendix, located next to the initial part of the large intestine. Normally, the thickness of the appendix is ​​up to 7 mm.

Gastric and duodenal ulcers on abdominal ultrasound

Peptic ulcer of the stomach and duodenum is a disease associated with the formation of defects in the mucous membrane under the influence of hydrochloric acid, pepsin, and microorganisms of the genus Helicobacter. Irregular nutrition is of great importance in the formation of ulcers. The ulcer is chronic with periodic exacerbations. The main symptom of ulcers is pain in the upper abdomen in the midline, appearing immediately after eating or on an empty stomach.

Diagnosis of gastric and duodenal ulcers using ultrasound is a difficult task, so ultrasound is rarely used for peptic ulcer disease. The ulcerative defect usually has a small depth, up to 2 mm, and not all ultrasound machines have sufficient resolution to detect it. An experienced doctor may notice unevenness of the layers of the stomach, but these signs cannot be considered completely reliable. In the initial stage of ulcer formation, when there is no significant defect ( mucosal erosion), an ultrasound examination will not provide any information at all. Therefore, in case of peptic ulcer, FGDS is more often performed.

With a long-standing ulcer, scarring occurs. In this case, there is a narrowing of the lumen of the stomach and a limitation of the capacity of the sphincters, especially when the ulcer is localized in the pyloric region. These changes are visible on ultrasound of the stomach. Due to scarring of the ulcer, the time for fluid evacuation during ultrasound with a water-siphon test increases. The wall of the stomach at the transition to the duodenum is unevenly thickened, and rough echoes appear in it, corresponding to the localization of scar tissue.

Chronic gastritis on abdominal ultrasound

Chronic gastritis is a disease accompanied by inflammation and degenerative changes in the wall of the stomach. Pain in chronic gastritis resembles pain in peptic ulcer disease, but is less acute. Heartburn, sour belching, periodic nausea and vomiting of gastric contents may occur. Chronic gastritis develops as a result of a large number of reasons.

Types and causes of chronic gastritis:

• A-type. Autoimmune damage, atrophy of the gastric mucosa.
• B-type. Bacterial infection ( helicobacter pylori).
• C-type. Chemical factors ( burns, poisoning).

Diagnosis of chronic gastritis is carried out using FGDS. Ultrasound of the stomach can reveal chronic gastritis only in a late stage. In this case, thickening of the stomach wall and the appearance of a pronounced folded structure on ultrasound are detected. The folds become noticeable because their height is about 20 mm. In severe chronic gastritis, ultrasound clearly distinguishes the ridges and valleys of the folds of the stomach.

Stomach tumors on ultrasound

Ultrasound diagnostics is useful for detecting tumors of the stomach wall exceeding 2 - 3 mm in size. Smaller tumors and polyps are detected only with special ultrasound equipment. Another big disadvantage of ultrasound is that it is impossible to reliably determine the nature of the tumor and its histological composition.

Benign stomach tumors are usually papillomas or adenomas. They are small in size ( up to 3 mm) and are detected on ultrasound only using a water-siphon test. During the filling of the stomach with liquid, the polyp rises above the wall of the stomach and is a rounded hypoechoic formation with smooth edges.

Malignant tumors of the stomach ( carcinomas) may have different shapes on ultrasound. The size of a malignant tumor on ultrasound of the stomach is much larger than a benign one, on average 15 mm. Carcinoma may be located at the site of the ulcer; in this case, against the background of the thickened wall of the stomach, a crater-shaped defect is revealed on the inner surface. Carcinoma may appear as a round formation with a lobular structure. In this case, its echogenicity is heterogeneous, and the edges are uneven. Duplex ultrasound reveals increased blood supply in the area of ​​the malignant tumor.

Intestinal obstruction on abdominal ultrasound

Intestinal obstruction is an acute condition in which the movement of the contents of the digestive tract is disrupted due to mechanical closure of the lumen or disruption of intestinal motor function. Intestinal patency can be impaired by adhesions, gallstones, foreign bodies, or volvulus. If intestinal patency is not restored as soon as possible, this can lead to necrosis of part of the intestine, peritonitis and serious condition of the patient.

Normally, intestinal loops are not visible on ultrasound. However, with intestinal obstruction, their characteristic image appears on ultrasound. The intestine stretches, its lumen becomes visible, it acquires an anechoic structure, as it is filled with gas and liquid. The mucosal folds form a scalloped edge and resemble a keyboard in the longitudinal plane or a staircase in the tangent plane. This picture is called the “keyboard symptom” or “stepladder”. The object causing the blockage is also visible on ultrasound as a round formation of homogeneous echogenicity.

Appendicitis on abdominal ultrasound

Appendicitis is an acute inflammation of the appendix. This disease is one of the most common reasons for surgical care. Appendicitis is caused by opportunistic intestinal microflora when the evacuation of its contents is impaired. Inflammation is provoked by the closure of the lumen of the appendix with intestinal contents, foreign bodies and other reasons. With appendicitis, pain appears in the lower right side of the abdomen. Within two days without treatment, purulent peritonitis develops.

Timely diagnosis is very important for the treatment of appendicitis. Using ultrasound, the diagnosis of appendicitis can be confirmed in 10 minutes. Therefore, for appendicitis, ultrasound is a necessary diagnostic procedure. On ultrasound, appendicitis is manifested by thickening of the wall of the appendix. Its diameter exceeds 7 mm. The appendix does not show peristaltic movements on ultrasound; with point pressure, pain appears, but its size does not decrease. A limited accumulation of fluid may be found in the abdominal cavity, and a large amount of gases in the intestines, which are produced by pathogenic bacteria.

To diagnose appendicitis using ultrasound, I use higher frequency sensors, which allow me to obtain images with better resolution. Sometimes an enlargement of the image is required due to the small size of the appendix.

Intestinal polyps on ultrasound

Tumors and polyps of the intestine, as well as when they are localized in the stomach, are difficult to examine using ultrasound. Due to the large extent of the intestine, ultrasound examination of polyps can only be carried out after their existence has been proven using endoscopy ( intraintestinal camera studies). In such cases, an ultrasound examination using a water-siphon test is additionally performed.

An intestinal polyp on ultrasound looks like a rounded hypoechoic formation adjacent to the intestinal wall. Polyps occur in 10% of people over forty years of age. Polyps themselves do not cause concern, but the formation of intestinal polyps is considered a precancerous disease. This means they have a chance of becoming cancerous. When polyps degenerate into a malignant tumor, pain appears during bowel movements, discharge of blood and mucus.

The formation of intestinal polyps is largely due to heredity, but doctors also note the connection between inflammatory bowel processes and their appearance. Poor diet, sedentary lifestyle, smoking - all this can cause the formation of polyps in the intestines.

Ultrasound of the spleen

The spleen is a hematopoietic organ. Here the maturation of lymphocytes occurs, the destruction of old and non-functional red blood cells. The spleen contains a large amount of blood, which is introduced into the vessels during physical activity. Because of this, spleen injuries are accompanied by massive internal bleeding. The spleen is not a vital organ, so in some conditions it is removed.

The spleen is removed in the following cases:

• blood diseases accompanied by damage to spleen cells ( leukemia);
• increased activity of the spleen in the destruction of red blood cells ( hypersplenism);

• excessive enlargement of the spleen ( splenomegaly);
• spleen injuries.

In any of the above cases, an ultrasound scan of the spleen is performed first, especially if an increase in its size is suspected. Examination of the spleen is a standard part of an abdominal ultrasound. Due to its location, the spleen is not accessible to clinical examination by palpation, so ultrasound is necessary to study it.

Image of a healthy spleen on abdominal ultrasound

The spleen is located in the upper left part of the abdominal cavity. It is located immediately under the dome of the diaphragm, bordering the left kidney, pancreas and large intestine. At the right edge of the spleen there is its gate - the place of entry of the splenic artery and vein.

The spleen is scanned in the left high lateral plane. In addition, her study is complemented by examination through the intercostal spaces. The structure of the spleen parenchyma should be homogeneous. Normally, the spleen has a hypoechoic structure compared to liver tissue. It has smooth edges, but in the area of ​​the gate it may have grooves. The spleen is crescent-shaped in transverse scanning and oval in cross-section.

Dimensions of the spleen on ultrasound

The spleen has certain sizes, which depend to a certain extent on the height and age of a person. They can be determined using ultrasound scanning at the depth of inspiration. Normally, the length of the spleen does not exceed 110 mm. The length of the spleen is the distance between the two most distant points on the longitudinal scanning plane. Spleen thickness ( anteroposterior size) does not exceed 50 mm, and the width at the gate level should be less than 70 mm. To the greatest extent, the size of the spleen depends on a person’s height, and not on age.

The size of the spleen plays an important role in the diagnosis of various diseases. It is known that an enlarged spleen often occurs in diseases of the liver and blood system. In these cases, its weight can be more than 5 kilograms.

Diffuse changes in the spleen on ultrasound. Splenomegaly

Diffuse changes in the spleen on ultrasound are changes that affect the entire organ. Most often they are accompanied by an increase in the size of the organ. In this case, the length of the spleen is more than 12 cm. This phenomenon is called splenomegaly. Splenomegaly on ultrasound is accompanied by an enlargement of the upper and lower poles of the spleen and dilation of blood vessels in the hilum area. Splenomegaly is a symptom that occurs in various diseases, and the true cause of an enlarged spleen is usually indicated by clinical and laboratory examination data.

Splenomegaly occurs in the following conditions:

• Infectious diseases. The infection can be located both in the spleen and outside it. Inflammatory causes of an enlarged spleen are indicated by an increase in leukocytes in the blood, fever, fatigue, and increased fatigue.
• Diseases of the lymphatic system. In diseases of the lymphatic system, many groups of lymph nodes become enlarged.
• Lesions of the hematopoietic system. They differ in changes in the general blood test.
• Hemolytic anemia. With this disease, the number of red blood cells in the blood decreases due to their accelerated destruction in the vessels and spleen.
• Liver diseases. With portal hypertension, venous congestion occurs in the veins of the abdominal cavity. Excess venous blood flows into the splenic vein, causing the spleen to increase in size.

The spleen may decrease in size, being less than 7 cm in length. A shrinkage of the spleen is associated with aging and also occurs while taking medications during a bone marrow transplant.

Splenic infarction on ultrasound

Splenic infarction is necrosis of an organ area due to acute circulatory disorders. It is caused by blockage of the lumen of the vessel with a blood clot, cells, or microorganisms. In the spleen, infarct areas are usually small, since the blood supply system is well developed in this organ. Most often, splenic infarction occurs with leukemia and some infections. A splenic infarction may go unnoticed by the patient, causing only passing discomfort in the form of pain on the left under the ribs.

Splenic infarction on ultrasound is determined by the following signs:

• hypoechoic focus within the splenic parenchyma;
• the size of the lesion may vary, but a wedge-shaped shape is more common;
• a hematoma may be present in the form of an anechoic area;
• Duplex ultrasound reveals a lack of blood flow at the site of the infarction.

Splenic infarction usually goes away on its own. Dead cells are replaced by connective tissue unnoticed by the patient. However, in some cases where massive necrosis occurs, surgery is required. It is also required when the vessels of the spleen are twisted to restore normal blood flow.

Splenic injury on ultrasound

For abdominal injuries, doctors always check the integrity of the spleen using ultrasound. Bleeding from this organ into the abdominal cavity is uncontrollable and quickly leads to a deterioration in the patient’s condition. In this case, for some time after the injury, the patient may feel that all symptoms are absent. A splenic rupture is an indication for its removal.

If the spleen is injured, ultrasound reveals free fluid in the abdominal cavity. It is anechoic or hypoechoic. There may be moving echoes within the blood collection. Sometimes injury to the spleen leads to the formation of hematomas without rupture of the capsule. In this case, the hematoma looks like an anechoic crescent-shaped area under the splenic capsule.

Rupture of the spleen and internal bleeding can occur not only due to injury to this organ. With infections, congestive splenomegaly and metastases of malignant tumors, there is also a risk of rupture.

Tumors of the spleen. Lymphoma of the spleen on ultrasound

The most common tumors of the spleen are hemangiomas and lymphomas. Hemangioma is usually detected incidentally during abdominal ultrasound. Hemangioma is a benign tumor that is a proliferation of blood vessels. In shape it can be capillary, cavernous ( abdominal) or mixed. Hemangioma on ultrasound looks like a rounded area of ​​increased echogenicity with smooth boundaries of various sizes. Hemangioma is a congenital formation, therefore it does not change with age. This sign is characteristic of establishing the benign nature of formations in the spleen.

Lymphoma is a malignant tumor that most often appears before the age of 30. Initially, lymphoma causes loss of appetite, premature feeling of satiety, and pain in the left hypochondrium. Subsequently, lymphoma is accompanied by weight loss and an unexplained increase in temperature. These symptoms should alert a person and conduct a full examination by a doctor.

Due to its malignancy, lymphoma requires prompt treatment. To diagnose lymphoma, it is necessary to analyze various types of examination. Typically, an ultrasound examination of the spleen is prescribed for abnormalities in the white blood count. Ultrasound is quite effective in diagnosing splenic lymphoma. On ultrasound, lymphoma appears as a hypoechoic formation of various shapes and sizes. Its structure may include heterogeneous areas. Typically, dynamic ultrasound allows one to distinguish between benign and malignant tumors, since the latter are characterized by progressive growth.

Ultrasound of the lymph nodes and vessels of the abdominal cavity ( aorta, inferior vena cava)

An abdominal ultrasound involves examining the large vessels of the abdominal cavity. Their examination in standard scanning mode reveals only morphological changes ( related to the shape and size of blood vessels). To determine hemodynamic parameters ( speed, pressure, direction of blood flow) a targeted examination of vessels with color Doppler mapping is necessary. This technique creates on the monitor screen a color scheme of blood moving in the vessels, depending on whether it is approaching or moving away from the sensor.

When scanning the vessels of the abdominal cavity, the following vessels are scanned:

• the aorta and the large arteries branching off from it ( renal, mesenteric, celiac trunk);

• inferior vena cava;
• portal vein;
• venous confluence ( splenic, mesenteric, gastric veins).

Examination of the vessels of the abdominal cavity is carried out in the following cases:

• vascular atherosclerosis;
• systemic vasculitis ( vascular inflammation);
• suspected aneurysm;
• kidney diseases and other conditions.

All of these conditions can be confirmed or refuted using ultrasound examination. If necessary, ultrasound of the abdominal vessels is supplemented with angiography or magnetic resonance imaging ( MRI) .

Normal abdominal ultrasound findings

Ultrasound scanning of the abdominal vessels is performed in the upper abdomen in the longitudinal and transverse plane. The aorta is located in front of the spinal column. Through the aorta, oxygenated blood flows from the heart to all internal organs. It looks like an anechoic smooth strip. The diameter of the abdominal aorta is about 2 centimeters. The aortic wall is a three-layer structure, of which the middle layer is less echogenic. The aorta pulsates during heart contractions, this pulsation can be seen on ultrasound. Arteries depart from the abdominal part of the aorta to all organs of the abdominal cavity, and below the navel it divides into two iliac arteries.

The inferior vena cava runs to the right of the aorta, parallel to it. The renal veins flow into it, but otherwise the venous blood flow differs from the arterial blood flow. Most of the veins from the abdominal organs flow into the portal vein; through the capillary blood flow of the liver, venous blood again enters the vena cava. The inferior vena cava has a thin wall, its lumen changes with respiratory movements.

The normal diameter of the portal vein is 11 mm. It is measured after the confluence of the splenic and mesenteric veins, at the head of the pancreas. The portal vein expands by several millimeters when you exhale. Portal vein examination is always performed in cases of liver disease.

Color Doppler mapping ( CDC) vessels of the abdominal cavity. Duplex ultrasound of the abdominal cavity

Using color Doppler mapping, the speed of blood flow in certain vessels is determined. The narrowing of the lumen of blood vessels leads to numerous pathological changes caused by a lack of oxygen supply to the organs. Clinical symptoms appear only when the lumen is closed ( stenosis) more than 70% of normal width. The aorta is a vessel with a very large lumen; therefore, the main tributaries of the aorta are examined, where the lumen is smaller and the likelihood of closing the lumen of the vessel by pathological changes in its wall is greater.

Such vessels are the celiac trunk and the superior mesenteric artery. The hepatic, gastric and splenic arteries depart from the celiac trunk. The vessels are better visible in the longitudinal plane. An indicator of vasoconstriction is the peak systolic velocity in them. When narrowing, it increases significantly, sometimes 2 times or more. In this case, an increase in blood flow velocity leads to various hemodynamic disorders. Due to increased pressure, vascular aneurysms may appear, and organs do not receive the required amount of oxygen, which is why functional failure develops.

Blood flow velocity in the celiac trunk and superior mesenteric artery under various conditions
The vessels of the portal system of the liver are also examined using color circulation. Venous blood flow is much slower. The normal speed of blood flow in the portal vein is 14 – 18 cm/sec. When blood stagnates, the speed of blood flow decreases, and the lumen of the portal vein increases.

Atherosclerosis of the aorta on abdominal ultrasound

Heart and vascular diseases are by far the most common causes of death. Atherosclerosis is a chronic disease of the arteries that occurs as a result of impaired metabolism of fats and proteins. Damage to vessel walls by atherosclerosis has many manifestations, but as a result, organs always suffer from a lack of blood supply. This condition is called ischemia. Diet, sedentary lifestyle, smoking, and stress play an important role in the formation of atherosclerosis.

With atherosclerosis, cholesterol is deposited in the artery wall in the form of atherosclerotic plaques. Atherosclerotic plaques can break away from the site of formation, forming a blood clot. Blood clots can lead to infarction of the heart, lungs, or other organs. Damage to the inner lining of blood vessels over time leads to the proliferation of connective tissue and the inclusion of calcium salts in the vascular wall. In this case, the walls of the vessel are deformed, and the lumen narrows. The narrowing of the lumen of blood vessels is called stenosis.

Ultrasound is a powerful tool for diagnosing atherosclerosis. Ultrasound can detect direct morphological changes in blood vessels. Ultrasound can detect atherosclerotic plaques, as well as detect deviations from the normal flow of blood through the vessels.

Signs of atherosclerosis on ultrasound are:

• Simple atherosclerotic plaques. They are deposits of cholesterol. On ultrasound they appear as focal echogenic thickenings of the intima, protruding up to 5 mm into the lumen of the vessel. They have smooth edges.
• Combined plaques. Such plaques include secondary vessel changes ( calcification, necrosis, ulceration). They have a height of more than 5 mm, uneven edges, and a hyperechoic structure due to the content of calcium salts and connective tissue.
• Hemodynamic disorders. They are detected using ultrasound with color Doppler mapping and confirm the diagnosis of aortic stenosis.

To treat atherosclerosis, medications are used that reduce the formation of lipids, but they are practically unable to affect existing changes in the arteries. Therefore, it is very important to monitor your health and lead a healthy lifestyle. This is the only way to keep the vessels in good condition.

Aortic aneurysm on abdominal ultrasound

An aneurysm is a protrusion of the wall of an artery due to congenital or acquired changes in its wall. The most common causes of aortic aneurysms are atherosclerosis and hypertension. An aneurysm is dangerous due to rupture of the vessel and massive internal bleeding, which is very difficult to stop even with timely assistance.

There are the following types of aortic aneurysms:

• Saccular. It is a unilateral protrusion of the aortic wall.
• Fusiform. With this type of aneurysm, the aorta is expanded evenly in all directions in a limited area. Its diameter in this area significantly exceeds normal, amounting to 3.5 cm or more.
• Delaminating. It is a defect in the vascular wall, in which a false channel is formed between the layers of the aortic wall. This condition is the most dangerous, since the remaining outer layers are even thinner and may not withstand the stress.
• False. Also called vascular hematoma because it occurs when the aorta is injured. A false aneurysm is confined to connective tissue and has a low risk of rupture.

Aortic aneurysm is most often an incidental finding on ultrasound. In other cases, the aneurysm is examined specifically if there is a suspicion of vascular pathology, hypertension or signs of atherosclerosis in a blood test. An aneurysm on ultrasound appears as an excessive expansion of the aortic lumen or is a protrusion associated with the main lumen of the vessel.

Aneurysms are usually found in older people, so surgery to remove them is not always performed. An aneurysm requires surgical treatment if it is larger than 5 cm. Even for smaller aneurysms, the risk of rupture within 5 years is about 5–15%. Therefore, she is being monitored dynamically using ultrasound. Aneurysms tend to grow, so aneurysms measuring 5 cm increase by 0.6 cm per year, and smaller ones by 0.2 cm. Rapid growth of an aneurysm is also an indication for surgical treatment.

Stagnation of blood in the venous system of the abdominal cavity. Signs on ultrasound examination

Blood stagnation in the abdominal veins is a condition in which the outflow of blood from the abdominal veins is obstructed, but the flow of blood through the arteries is normal. Venous congestion occurs in a large number of diseases and leads to portal hypertension. The pressure in the portal vein rises to 250 - 600 millimeters of water. Indirect signs of portal hypertension are unexplained shortness of breath and swelling of the legs.

Among the causes of venous stagnation in the abdominal cavity, the most important are:

• Heart failure. Heart disease leads to decreased cardiac output. Blood that should normally circulate accumulates in excess in the veins of the abdominal cavity.
• Chronic venous insufficiency. Insufficiency of the vein valves in the lower extremities leads to the fact that blood is not evacuated from them. In this case, the passage of blood in the veins of the abdominal cavity is disrupted.
• Liver diseases. In liver diseases, the liver parenchyma is replaced by connective tissue and the lumen of the veins narrows, which interferes with the normal movement of blood.
• Thrombosis of the abdominal veins. It does not occur so often, since the veins have a large lumen relative to the arteries, however, at a low speed of blood movement in the veins, the process of blood clotting and the formation of blood clots can be activated.

Signs of venous stagnation on ultrasound are dilation of the lumen of the veins and a decrease in the speed of blood flow. The vena cava becomes more than 20 mm in diameter. To determine the presence of blood stagnation in the portal vein system, the so-called stagnation index ( FROM). To measure it, ultrasound with Doppler ultrasound is required. The stagnation index is equal to the ratio of the area of ​​the portal vein on a cross section to the blood flow velocity at the same point. Normally, it is equal to 0.07; with severe stagnation of venous blood, it becomes equal to 0.17. This is observed, for example, in liver cirrhosis.

Ultrasound of the lymph nodes of the abdominal cavity. Enlarged lymph nodes on ultrasound

The lymphatic system of the abdominal cavity is a system of small vessels and nodes located in all organs of the abdominal cavity. Thanks to them, the body is protected with the help of white blood cells, removing excess fluid, toxins and foreign substances. Lymph nodes are located along large vessels and at the gates of all organs - liver, pancreas, spleen, stomach.

The following groups of lymph nodes are located in the abdominal cavity:

• lumbar;
• gastric;
• hepatic;
• pancreas;
• splenic;
• mesenteric.

Lymph nodes normally range in size from a few millimeters to 2 centimeters. They are usually located in groups. Using ultrasound, you can determine their shape, size, and degree of echogenicity. Normally, lymph nodes on ultrasound have average echogenicity and a homogeneous structure. Enlarged lymph nodes of more than 2 centimeters are the first sign of inflammatory diseases of the abdominal organs. This sign can be observed in hepatitis, colitis, salmonellosis, acute and chronic gastritis and other diseases. Enlargement of the lymph nodes of the abdominal cavity to gigantic sizes ( 5 centimeters or more) speaks of tumor diseases of the lymphatic system. They require a full examination using magnetic resonance or computed tomography ( CT) .

Ultrasound has limited capabilities in diagnosing conditions of the lymphatic system. Enlarged lymph nodes can only be regarded as a symptom indicating the presence of inflammation in the abdominal organs. For a more accurate diagnosis and identification of the causes of enlarged lymph nodes, a complete examination is required, including a biochemical blood test. An ultrasound of all abdominal organs can also help identify the organ that is susceptible to inflammation.

Interpretation of ultrasound of the abdominal cavity

Interpretation of abdominal ultrasound is the responsibility of the doctor conducting the ultrasound examination. It should be borne in mind that the result of the study is intended, first of all, for the attending physician, and not for the patient. The patient does not need to understand the intricacies of medical reports and diagnoses. However, if you wish, you can address all your questions to a sonologist. This is the name given to a specialist in the field of ultrasound diagnostics.

The result of an ultrasound examination is a conclusion, which is sometimes accompanied by a static photo demonstrating the described changes. The conclusion is not a diagnosis, but contains a description of the size of the organs and the presence of various deviations from the norm. It describes the picture that the sonologist saw during the examination on the screen of the ultrasound machine. The conclusion is necessary for the attending physician to establish the correct diagnosis and prescribe the correct treatment.

Sample abdominal ultrasound form

The conclusion about the ultrasound examination performed is issued on a form of a certain form. This form may vary depending on the healthcare facility. However, in any case, it contains the data in full. When filling it out, which is performed in parallel with the ultrasound examination, the doctor or nurse writes down data on the condition of the organ, its size and echogenicity. When pathological changes are detected in an organ, all its characteristics are described in detail.

The abdominal ultrasound report form contains the following information:

• Description of the liver. The linear dimensions of the right and left lobes of the liver, the echogenicity of the capsule and parenchyma are indicated. The nature of the vascular pattern of the liver is also clarified.
• Description of the gallbladder and bile ducts. When describing the gallbladder, its length, wall thickness, and the presence or absence of stones are indicated. A very important indicator of stones is the presence of an acoustic shadow, which is also noted in the conclusion. The diameter of the common bile duct is indicated.
• Description of the pancreas. In the pancreas, the thickness of each part is indicated ( head, body and tail), the diameter of the pancreatic duct and the echogenicity of its parenchyma.
• Description of the spleen. Contains the dimensions of the spleen ( length and width), splenic vein diameter and general echogenicity.
• Description of the stomach and intestines. The stomach and intestines are assessed superficially during a conventional ultrasound examination. When detected, damage to the walls, fluid accumulation, and intestinal dilation are indicated.
• Description of the vessels of the abdominal cavity. The diameter of the abdominal aorta, inferior vena cava, and portal vein is indicated. Signs of atherosclerosis, local narrowing or dilatation of blood vessels are also indicated here.
• Tumors and abnormal formations of any abdominal organs. Abnormal formations are described in the part of the form corresponding to the organ in which it is located. The size, contours, and echogenicity of the formation are indicated.

It takes up to 30 minutes to fill out all the information. At the end of the report, all identified deviations from the norm are indicated again using medical terms. The ultrasound report is invalid without the seal and signature of the doctor who conducted the study.

Diffuse changes in the abdominal organs on ultrasound

Often in the conclusion of an ultrasound scan you can find the phrase “diffuse changes” in various organs. It refers to organs with parenchyma - liver, pancreas, spleen. On an ultrasound image, diffuse changes in parenchymal organs represent abnormal echogenicity. They correspond to changes in organs at the cellular level. Fatty inclusions appear in the cells of the listed organs, and the functional part of the organ is replaced by connective tissue.

Diffuse changes in the abdominal organs occur in advanced chronic diseases. They may be chronic hepatitis and pancreatitis. In the case of atherosclerosis, diffuse changes in the aortic wall may be observed. To prevent such changes, you should regularly conduct preventive examinations and monitor your lifestyle and diet. Diffuse changes in internal organs are, as a rule, an irreversible process, which can significantly reduce life expectancy.

Free fluid in the abdominal cavity on ultrasound ( ascites)

A separate line in the ultrasound report indicates the presence or absence of fluid in the abdominal cavity and retroperitoneal space. The presence of fluid in the abdominal cavity is called ascites. On ultrasound, the fluid appears as an anechoic area with rare echogenic inclusions. This is important information, since free fluid in the abdominal cavity appears only as a result of pathological processes. When infected, this fluid becomes purulent and peritonitis develops.

The following are the reasons for the appearance of fluid in the abdominal cavity:

• trauma to the abdominal organs with intra-abdominal bleeding;
• appendicitis;
• hepatitis and cirrhosis of the liver;
• portal hypertension;
• tumors of the abdominal organs;
• purulent diseases, abscesses, phlegmons.

Most often, fluid accumulates in the liver, spleen, and pelvis. The presence of fluid in the abdominal cavity requires its puncture and elimination of the causes of its appearance. The reasons for the appearance of fluid can be determined during the same ultrasound examination; its localization near the affected organs plays a large role in this.

Adhesions on abdominal ultrasound

The formation of adhesions in the abdominal cavity is a specific condition. Adhesions are strands of connective tissue that form in places where the integrity of the peritoneum is disrupted. In 99% of cases, adhesions are formed after abdominal surgery and represent the body’s defensive reaction to interference in the internal environment. The extent of the adhesive process depends on how wide the surgical access was. The danger of adhesions is that adhesions can compress intestinal loops and cause intestinal obstruction.

Ultrasound has several advantages for diagnosing adhesive disease. Among them are harmlessness, speed of research, absence of side effects and the possibility of observation over time. The adhesive strands have a high density, so on ultrasound they appear as hyperechoic areas. An indirect sign of adhesive disease is the unusual position of the internal organs. Unfortunately, at the beginning of adhesive disease, the cords are small in size and density, so they are almost impossible to detect.

Adhesive disease requires surgical treatment if complications develop. Unfortunately, it is impossible to prevent it. Currently, so-called laparoscopic operations are performed with an incision of several centimeters. This reduces the risk of adhesions forming.

Diagnosis of cancer and metastases using abdominal ultrasound

Diagnosing cancer using abdominal ultrasound is inaccurate. This is explained by the fact that there is a wide variety of tumor processes, both benign and malignant. Differences in echogenicity on ultrasound do not allow one to accurately determine the type of tumor, and this is fundamental in its treatment. In addition, small tumors ( up to 3 mm) are not detected on ultrasound, which is why diagnosis may be delayed. This may have a bad effect on the prognosis of treatment. To diagnose tumors, the physician performing the ultrasound requires extensive experience in recognizing tumors.

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