1、Abdominal And Superficial Ultrasound Cheng JuanNormal ultrasoNormal ultrasoundund images;images;Abnormal ultrasoAbnormal ultrasoundund indications.indications.Superficial ultrasound:Superficial ultrasound:t thyroidhyroid、breastbreast.Abdominal Abdominal ultrasound:ultrasound:l liveriver、g gall bladd
2、erall bladder、pancreaspancreas、kidneykidney、spleenspleen.h homogeneouomogeneous s 均匀均匀的的heterogeneous heterogeneous 不不均匀的均匀的microcalcificationmicrocalcification 微钙化微钙化 acoustic attenuation acoustic attenuation 声声衰减衰减acoustic shadowacoustic shadow 声影声影peripheral peripheral halo halo 晕晕环环anechoicanech
3、oic无回声无回声hypoechoichypoechoic低回声低回声isoechoicisoechoic等回声等回声hyperechoichyperechoic高回声高回声Routine physicalRoutine physical examination examinationAcuteAcutea abdomenbdomendiseasediseaseUltrasound guided puncture Ultrasound guided puncture Which Which probe probe is used for is used for abdominal ultras
4、ound abdominal ultrasound examinationexamination？convex convex array array probe:35 MHzprobe:35 MHzsagittal planesagittal planetransverse planetransverse planeoblique planeoblique planecoronal coronal planeplaneLiver:parenchyma-homogeneousLiver:parenchyma-homogeneousand isoechoic;membrane-linear and
5、 isoechoic;membrane-linear hyperechoic.hyperechoic.oblique diameter of oblique diameter of right lobe:1014cm right lobe:1014cm anteroposterior anteroposterior diameterdiameter of right lobe:810cm of right lobe:810cm T The first hepatic he first hepatic portalportal:portal vein:portal vein、common bil
6、e ductcommon bile duct、hepatic artery.hepatic artery.portal vein:portal vein:10 1012mm12mmc common bile duct:1/3ommon bile duct:1/3PW:PW:stationary wave wstationary wave with ith respiratory fluctuations respiratory fluctuationsThe second The second hepatic hepatic portal:the junction ofportal:the j
7、unction oft three hepatic hree hepatic vein and inferior vena vein and inferior vena cava.cava.left hepatic veinleft hepatic veinmiddle hepatic veinmiddle hepatic veinright hepatic veiright hepatic vein nPW:PW:three phase wavethree phase waveLobes of liver:interrupted Lobes of liver:interrupted by b
8、y hepatic veins.hepatic veins.r right anterior lobe ight anterior lobe r right posterior lobeight posterior lobel left internal lobeeft internal lobeleft lateral lobe left lateral lobe Spleen:parenchyma-homogeneous Spleen:parenchyma-homogeneous isoechoicisoechoic;membrane-linear membrane-linear hype
9、rechoic;splenic portal.hyperechoic;splenic portal.Length diameter:812cmLength diameter:812cmPachyPachy diameter:34cm diameter:34cmSplenic vein:1cmSplenic vein:5.0cm)2.massive mass type(5.0cm)1.diffuse infiltrative type1.diffuse infiltrative type3.nodular type(5.0cm)3.nodular type(5.0cm)1.1.2.2.3.3.P
10、rimary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）small carcinoma type small carcinoma type（小肝癌小肝癌）:肝内出现单个癌结节且直径肝内出现单个癌结节且直径3cm者，或肝内者，或肝内癌结节不超过癌结节不超过2 2个且直径之和个且直径之和3cm者。者。Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(1)It appears as single or multiple solid(1)It appears a
11、s single or multiple solid masses;usually the solid masses show masses;usually the solid masses show indistinct border-indistinct border-肝内单发或多发实性结节，肝内单发或多发实性结节，边界多不清楚边界多不清楚.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(2)The echo levels can be different(2)The echo levels can be dif
12、ferent-内部内部回声可呈低回声、等回声、高回声或混合回声回声可呈低回声、等回声、高回声或混合回声,分分布均匀或不均匀布均匀或不均匀.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(3)In some masses,(3)In some masses,the“Nodulethe“Nodule in Nodule”in Nodule”pattern or“Mosaic”pattern are often seen-pattern or“Mosaic”pattern are often seen-可出现结中结或马赛克
13、样表现可出现结中结或马赛克样表现.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(4)Periphery halo:It is thin hypoechoic(4)Periphery halo:It is thin hypoechoic stripstrip（2-5mm2-5mm）around the mass-around the mass-结节周边可结节周边可有低回声薄晕环有低回声薄晕环.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(
14、5)In the most masses of HCC,CDFI(5)In the most masses of HCC,CDFI can show the blood flow-can show the blood flow-结节内部及周边结节内部及周边多见线状、分支状彩色血流信号多见线状、分支状彩色血流信号.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(6)Contrast enhanced ultrasound:(6)Contrast enhanced ultrasound:fast enhancement
15、and clearance-fast enhancement and clearance-超声造影表现为超声造影表现为“快进快出快进快出”.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(1)Oppressing signs(1)Oppressing signs：“hump Sign”-“hump Sign”-较大或位较大或位于肝包膜下的肿块可引起局部肝包膜膨隆于肝包膜下的肿块可引起局部肝包膜膨隆;the;the vessels or bile ducts in liver can be vessels or bil
16、e ducts in liver can be oppressed-oppressed-肝内管道受压变细或移位肝内管道受压变细或移位.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(2)Metastatic signs:emboli of carcinoma(2)Metastatic signs:emboli of carcinoma in portal vein-in portal vein-门静脉癌栓门静脉癌栓.Primary hepatic carcinomaPrimary hepatic carcinoma（
17、原发性肝癌原发性肝癌）(2)Metastatic signs:emboli of carcinoma(2)Metastatic signs:emboli of carcinoma in hepatic vein-in hepatic vein-肝静脉癌栓肝静脉癌栓.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(2)Metastatic signs:emboli of carcinoma(2)Metastatic signs:emboli of carcinoma in inferior vena cava-in i
18、nferior vena cava-下腔静脉癌栓下腔静脉癌栓.Primary hepatic carcinomaPrimary hepatic carcinoma（原发性肝癌原发性肝癌）(2)Metastatic signs:liver satellite(2)Metastatic signs:liver satellite nodules-nodules-肝内卫星灶肝内卫星灶.Hepatic Hepatic hemangiomahemangioma（肝血管瘤肝血管瘤）single or multiple solid masses;well-single or multiple solid m
19、asses;well-defined lesions;heterogeneous and defined lesions;heterogeneous and sieve-like.-sieve-like.-肝内单发或多发实性结节，边界清肝内单发或多发实性结节，边界清楚，内部回声不均匀，可见低回声、等回声、高楚，内部回声不均匀，可见低回声、等回声、高回声，呈筛网状。回声，呈筛网状。Hepatic Hepatic hemangiomahemangioma（肝血管瘤肝血管瘤）CDFI/PW:avascular on ultrasound-CDFI/PW:avascular on ultrasound
20、-结节结节内部不易探及彩色血流信号，周边可探及点状、内部不易探及彩色血流信号，周边可探及点状、线状彩色血流信号线状彩色血流信号.Hepatic cystHepatic cyst（肝囊肿肝囊肿）anechoic-anechoic-无回声无回声;with thin,smooth wall-with thin,smooth wall-壁薄、光滑壁薄、光滑;posterior acoustic enhancement-posterior acoustic enhancement-后方回声增强后方回声增强.absent blood flow signal-absent blood flow signal
21、-无血流信号无血流信号.Gall bladder:divided Gall bladder:divided into the neck,the into the neck,the body body and and the fundusthe fundus;cavity-anechoic;cavity-anechoic;wall-hyperechoicwall-hyperechoic.long axislong axisshort axisshort axisCholecystolithiasisCholecystolithiasis（胆囊结石胆囊结石）According to the dif
22、ferent chemical According to the different chemical components,it is divided into three components,it is divided into three types:cholesterol stone,pigment stone,types:cholesterol stone,pigment stone,and mixed stones.and mixed stones.CholecystolithiasisCholecystolithiasis（胆囊结石胆囊结石）Typical gallstone:
23、Typical gallstone:the mass of strong echo-the mass of strong echo-团状强回声团状强回声;posterior acoustic shadow-posterior acoustic shadow-后方伴有声影后方伴有声影.CholecystolithiasisCholecystolithiasis（胆囊结石胆囊结石）Typical gallstone:Typical gallstone:move with changing of body position-move with changing of body position-随体
24、位改变而移动随体位改变而移动.CholecystolithiasisCholecystolithiasis（胆囊结石胆囊结石）Atypical gallstone:Atypical gallstone:(1)(1)gallbladder full of stonesgallbladder full of stones（充满型胆囊结石充满型胆囊结石）:“WES”sign-“WES”sign-即囊壁结石声影三联征，前方为增厚即囊壁结石声影三联征，前方为增厚胆囊壁的弱回声包绕中间结石的强回声，后方伴声影胆囊壁的弱回声包绕中间结石的强回声，后方伴声影.CholecystolithiasisCholec
25、ystolithiasis（胆囊结石胆囊结石）Atypical gallstone:Atypical gallstone:(2)sand-like stone(2)sand-like stone（泥沙样胆囊结石泥沙样胆囊结石）:high-echo dots in gallbladder cavity high-echo dots in gallbladder cavity without shadow.without shadow.CholecystolithiasisCholecystolithiasis（胆囊结石胆囊结石）Atypical gallstone:Atypical gallst
26、one:(3)stone located in neck of gallbladder(3)stone located in neck of gallbladder（胆囊颈部结石胆囊颈部结石）:not move with changing of body position.not move with changing of body position.Acute Acute cholecystitischolecystitis（急性胆囊炎急性胆囊炎）95%of acute 95%of acute cholecystitischolecystitis are combined are combi
27、ned with gallstones.The symptoms mainly with gallstones.The symptoms mainly include acute right upper quadrant pain include acute right upper quadrant pain and Murphy Sign is positive.and Murphy Sign is positive.Acute Acute cholecystitischolecystitis（急性胆囊炎急性胆囊炎）(1)enlarged gallbladder-(1)enlarged ga
28、llbladder-胆囊肿大胆囊肿大;(2)thick diffusely wall(2)thick diffusely wall（CDFI-show CDFI-show the blood flowthe blood flow）-胆囊壁弥漫性增厚，可见胆囊壁弥漫性增厚，可见丰富血流信号丰富血流信号;Acute Acute cholecystitischolecystitis（急性胆囊炎急性胆囊炎）(3)some debris-like echoes-(3)some debris-like echoes-胆囊内透声性差，胆囊内透声性差，可见点状、片状或絮状高回声，无声影，可移动可见点状、片状或
29、絮状高回声，无声影，可移动;(4)localized echo-free around gallbladder-(4)localized echo-free around gallbladder-胆囊周围可见液性暗区胆囊周围可见液性暗区;(5)ultrasound Murphy Sign-(5)ultrasound Murphy Sign-超声超声MurphyMurphy征阳性征阳性.P Pancreaseancrease:splenic veinsplenic veinpancreasepancreaseinferior vena cavainferior vena cava abdomin
30、al aortaabdominal aortaParenchyma:Parenchyma:homogeneouhomogeneous,s,isoechoic;isoechoic;Pancreatic duct:Pancreatic duct:2mm.1.5cm).separated by echo-free(1.5cm).In mild degree,the kidney is in normal sizeIn mild degree,the kidney is in normal size，and the parenchyma of kidney is normal-and the pare
31、nchyma of kidney is normal-轻度肾积水时，肾盂肾盏轻度扩张，肾的大小、形态轻度肾积水时，肾盂肾盏轻度扩张，肾的大小、形态、实质均无改变、实质均无改变.HydronephrosisHydronephrosis（肾积水肾积水）In moderate degree,the parenchyma of In moderate degree,the parenchyma of kidney is thin-kidney is thin-中度肾积水时，肾盂肾盏扩张呈花中度肾积水时，肾盂肾盏扩张呈花朵样，肾的大小、形态正常，实质正常或稍变薄朵样，肾的大小、形态正常，实质正常或稍变薄
32、.In severe degree,the kidney is enlargedIn severe degree,the kidney is enlarged，and the parenchyma almost disappears-and the parenchyma almost disappears-重重度肾积水时，肾盂肾盏扩张呈调色板样，肾脏增大，度肾积水时，肾盂肾盏扩张呈调色板样，肾脏增大，形态失常，实质明显变薄甚至消失形态失常，实质明显变薄甚至消失.Renal carcinomaRenal carcinoma（肾肾癌癌）a large,heterogeneous mass whic
33、h a large,heterogeneous mass which enlarges and deforms the shape of the enlarges and deforms the shape of the kidney.The mass may contain areas of kidney.The mass may contain areas of cystic degeneration and/or calcification.cystic degeneration and/or calcification.Renal carcinomaRenal carcinoma（肾肾
34、癌癌）CDFI usually reveals a disorganized and CDFI usually reveals a disorganized and increased blood flow pattern within the increased blood flow pattern within the mass.mass.It is located in the neck anteriorly.It It is located in the neck anteriorly.It consists of two lobes.The two lobes are consist
35、s of two lobes.The two lobes are connected by the thin isthmus.connected by the thin isthmus.l linear inear array probe array probe:512 MHz512 MHzThyroid GlandThyroid Gland:the:the shape of butterfly;shape of butterfly;isoechoic;isoechoic;homogenoushomogenous.c commomommom carotid artery carotid art
36、eryinternal internal jugular jugular veinveintrachea trachea Hyperthyroidism(Graves Hyperthyroidism(Graves Disease Disease)（甲状腺功能亢进甲状腺功能亢进）It is regarded as an autoimmune disorder.It is regarded as an autoimmune disorder.The main symptoms include diffusely The main symptoms include diffusely enlarge
37、ment of thyroid gland,tachycardia,enlargement of thyroid gland,tachycardia,bulging eyes and skin thickening.bulging eyes and skin thickening.Hyperthyroidism(Graves Hyperthyroidism(Graves Disease Disease)（原发性原发性甲状腺功能亢进甲状腺功能亢进）(1)The thyroid gland is enlarged(1)The thyroid gland is enlarged symmetrica
38、lly and diffusely;symmetrically and diffusely;(2)The internal echoes vary.It may(2)The internal echoes vary.It may appear as diffuse hypoechoic.appear as diffuse hypoechoic.Hyperthyroidism(Graves Hyperthyroidism(Graves Disease Disease)（原发性原发性甲状腺功能亢进甲状腺功能亢进）(3)CDFI:The blood flow increase(3)CDFI:The
39、blood flow increase markedly and we often call this markedly and we often call this“Flames Sea Sign”-“Flames Sea Sign”-火海征火海征.Hyperthyroidism(Graves Hyperthyroidism(Graves Disease Disease)（原发性原发性甲状腺功能亢进甲状腺功能亢进）The history,symptoms and laboratory The history,symptoms and laboratory results(T3,T4)are
40、very important to results(T3,T4)are very important to the diagnosis.the diagnosis.Adenoma of Thyroid GlandAdenoma of Thyroid Gland（甲状腺腺瘤甲状腺腺瘤）(1)usually single,round or oval-(1)usually single,round or oval-一般为单发，一般为单发，呈圆形或椭圆形呈圆形或椭圆形;(2)hypoechoic or isoechoic-(2)hypoechoic or isoechoic-低回声或等回声低回声或等回
41、声;(3)If cystic change or hemorrhage occurs,(3)If cystic change or hemorrhage occurs,echo-free can be seen-echo-free can be seen-合并囊性变、出血或坏死合并囊性变、出血或坏死时可见不规则无回声区时可见不规则无回声区;Adenoma of Thyroid GlandAdenoma of Thyroid Gland（甲状腺腺瘤甲状腺腺瘤）(4)the border is well-defined and usually(4)the border is well-define
42、d and usually there is thin periphery halo-there is thin periphery halo-边界清楚，可见边界清楚，可见薄晕环薄晕环;(5)CDFI shows blood flow around and(5)CDFI shows blood flow around and within the mass-within the mass-周边常见环绕血管，内部多见周边常见环绕血管，内部多见丰富血流丰富血流.Adenoma of Thyroid GlandAdenoma of Thyroid Gland（甲状腺腺瘤甲状腺腺瘤）Contrast
43、enhanced ultrasound:Contrast enhanced ultrasound:fast enhancement and slow fast enhancement and slow clearance-clearance-超声造影表现为超声造影表现为“快进慢出快进慢出”.Carcinoma of Thyroid Carcinoma of Thyroid GlandGland（甲状腺癌甲状腺癌）Four types:papillary,follicular,medullary Four types:papillary,follicular,medullary and undi
44、fferentiated.The papillary and undifferentiated.The papillary carcinoma is the most common type.carcinoma is the most common type.Carcinoma of Thyroid Carcinoma of Thyroid GlandGland（甲状腺癌甲状腺癌）(1)single;hypoechoic;heterogeneous;(1)single;hypoechoic;heterogeneous;(2)the border is indistinct;(2)the bor
45、der is indistinct;(3)posterior acoustic attenuation;(3)posterior acoustic attenuation;Carcinoma of Thyroid Carcinoma of Thyroid GlandGland（甲状腺癌甲状腺癌）(4)(4)microcalcificationsmicrocalcifications:tiny(1mm).:tiny(1-(3)aspect ratio1-纵横比纵横比1;1;Carcinoma of Carcinoma of BreastBreast（乳腺癌乳腺癌）(4)the border is
46、 indistinct:(4)the border is indistinct:spiculatespiculate sign,sign,crab foot sign-crab foot sign-边界不清楚，可见毛刺、蟹足征边界不清楚，可见毛刺、蟹足征;(5)(5)microcalcificationsmicrocalcifications-微钙化微钙化;(6)posterior acoustic(6)posterior acoustic attenuationattenuation-后方回声衰后方回声衰减减;Carcinoma of Carcinoma of BreastBreast（乳腺
47、癌乳腺癌）(7)CDFI can show rich and irregular blood(7)CDFI can show rich and irregular blood flow-flow-内部及周边可见不规则丰富血流信号内部及周边可见不规则丰富血流信号.Carcinoma of Carcinoma of BreastBreast（乳腺癌乳腺癌）(8)PW:high velocity with high resistance-(8)PW:high velocity with high resistance-高速、高阻血流频谱高速、高阻血流频谱.Carcinoma of Carcinoma
48、 of BreastBreast（乳腺癌乳腺癌）(9)Metastatic signs:subcutaneous fat(9)Metastatic signs:subcutaneous fat and skin layer,and skin layer,retromammaryretromammary layer-layer-库柏库柏韧带连续性中断、皮肤水肿增厚，肌层连续性中断韧带连续性中断、皮肤水肿增厚，肌层连续性中断;Carcinoma of Carcinoma of BreastBreast（乳腺癌乳腺癌）(10)Metastatic signs:axillary lymph node,
49、(10)Metastatic signs:axillary lymph node,liver-liver-腋窝淋巴结肿大、肝内转移灶腋窝淋巴结肿大、肝内转移灶.形状规则、椭圆形或浅分叶规则、椭圆形或浅分叶不规则、深分叶不规则、深分叶边界清晰，有完整包膜清晰，有完整包膜多不清晰，毛刺或蟹足多不清晰，毛刺或蟹足内部回声较均匀低回声较均匀低回声不均匀低回声不均匀低回声钙化灶少见，较粗大少见，较粗大多见，沙砾样多见，沙砾样后方回声增强或无改变增强或无改变衰减多见衰减多见侧方声影有有无无纵横比1周围组织及淋巴结受累无无有有血供及动脉频谱多不丰富，低速低阻型多不丰富，低速低阻型多丰富，高速高阻型多丰富，高速高阻型乳腺乳腺肿瘤的良恶性肿瘤的良恶性鉴别鉴别:THANK YOU!
