Normal size of liver and spleen: Evaluation of the Size, Shape, and Consistency of the Liver – Clinical Methods
Normal Liver Size and Your Health
Your liver grows as you age, though certain health conditions, including acute hepatitis and fatty liver disease, can cause an enlarged liver. A large liver doesn’t always cause symptoms.
The liver is the body’s largest and heaviest internal organ. It serves many important purposes, including regulating levels of chemicals in the blood, making bile to digest fats, and making cholesterol, blood plasma proteins, and immune factors.
In adults, the liver weighs a little more than 3 pounds.
As you age, the liver varies in size, and certain health conditions can enlarge it.
Men tend to have a larger liver size than women. This is usually because men’s bodies tend to be larger. While liver sizes can vary slightly, there are some studies about the average liver size by age.
One such study was published in the journal Indian Pediatrics. The researchers performed ultrasound evaluation of 597 healthy children between the ages of 1 and 12 years.
The following are the results of the study measuring the average liver length for boys:
| Age | Liver length (Boys) |
| 1 to 3 months | 2.6 in. (6.5 cm) |
| 3 to 6 months | 2.8 in. (7.1 cm) |
| 6 to 12 months | 3.0 in. (7.5 cm) |
| 1 to 2 years | 3.4 in. (8.6 cm) |
| 2 to 4 years | 3.5 in. (9.0 cm) |
| 4 to 6 years | 4.1 in. (10.3 cm) |
| 6 to 8 years | 4.3 in. (10.8 cm) |
| 8 to 10 years | 4.7 in. (11.9 cm) |
| 10 to 12 years | 5.0 in. (12.6 cm) |
The following are the results for liver length in girls:
| Age | Liver length (Girls) |
| 1 to 3 months | 2.4 in. (6.2 cm) |
| 3 to 6 months | 2.8 in. (7.2 cm) |
| 6 to 12 months | 3. 1 in. (7.9 cm) |
| 1 to 2 years | 3.3 in. (8.5 cm) |
| 2 to 4 years | 3.5 in. (8.9 cm) |
| 4 to 6 years | 3.9 in. (9.8 cm) |
| 6 to 8 years | 4.3 in. (10.9 cm) |
| 8 to 10 years | 4.6 in. (11.7 cm) |
| 10 to 12 years | 4.8 in. (12.3 cm) |
Liver size can vary by sex, body mass index, height, amount of alcohol consumed, and many other factors.
An older study published in the Journal of Ultrasound in Medicine measured the average liver diameter of more than 2,080 male and female participants between 18 and 88 years old at the midclavicular line, which is an imaginary line moving down your body starting from the middle of your collarbone.
The study’s results found the following:
| Age | Average liver diameter |
| 18 to 25 years | 5.4 in. (13.6 cm) |
| 26 to 35 years | 5. 4 in. (13.7 cm) |
| 36 to 45 years | 5.5 in. (14.0 cm) |
| 46 to 55 years | 5.6 in. (14.2 cm) |
| 56 to 65 years | 5.7 in. (14.4 cm) |
| Greater than 66 years | 5.6 in. (14.1 cm) |
The study represents one of the largest populations studied regarding average liver length, and it concluded that the average liver size in adults was 5.5 inches (in.), or 14 centimeters (cm).
Doctors use imaging studies to estimate liver size. Sometimes, when the liver is extremely enlarged, a doctor can identify the enlargement on an X-ray. When they want greater accuracy, they’ll usually use ultrasound.
Ultrasound is a painless imaging technique that uses sound waves to compare solid organs with other surroundings, such as blood. Because ultrasound uses sound waves, it doesn’t expose a person to radiation, like many imaging techniques do.
Typically, a person who specializes in ultrasound, known as an ultrasonographer, or a liver doctor will perform the ultrasound.
You’ll lie down, and they’ll use a special wand device to transmit images of the liver to an ultrasound screen. The size of the liver is measured on the screen.
The liver isn’t a proportional organ. Its lobes are different sizes and can be larger and smaller in areas depending on where the ultrasound professional is taking measurements. These differences can cause some variance accuracy. A doctor will also usually compare these results with other imaging studies, which may include a CT scan.
The condition of having an enlarged liver is called hepatomegaly. When the liver gets larger, it doesn’t always cause symptoms. Some people may report a feeling of abdominal fullness or pressure.
A variety of medical conditions can cause an enlarged liver.
Acute hepatitis
Acute hepatitis is inflammation of the liver caused by one of the five hepatitis viruses. The body may clear the virus or a person can develop chronic hepatitis, such as hepatitis B or hepatitis C.
Biliary atresia
Biliary atresia is a rare condition that affects the size or presence of the bile ducts.
It often requires surgery to treat.
Cirrhosis
Cirrhosis can be the result of chronic alcohol consumption, hepatitis, or other liver-related conditions. Treatments for cirrhosis slow the progression of further scarring.
Fatty liver
Fatty liver is a condition that can occur due to heavy alcohol use or having more weight. It can be reversed in early stages with weight loss and abstaining from alcohol.
Infectious mononucleosis
Infectious mononucleosis is a viral disease caused by the Epstein-Barr virus. Many people will feel better in 2 weeks to several months.
Liver cancer
Various cancers can affect the liver. Treatments depend on the cancer type but may include surgery and radiation.
Right heart failure
Right heart failure can cause excess fluid to build up in the liver’s blood vessels. Treatments usually aim to reduce fluid buildup and improve heart function in this serious heart failure side effect.
Additionally, rare diseases like Gaucher’s disease, Wilson’s disease, or Niemann-Pick disease can cause liver enlargement.
Treatments for these diseases depend on the condition.
If you have an enlarged liver, your doctor will likely consider your overall symptoms, medical history, and imaging and blood studies before making a diagnosis.
Because your liver is so vital to your health, you should do the following to maintain good liver health:
- Maintain a healthy weight for you. Having more weight can lead to a condition called non-alcoholic fatty liver disease.
- Exercise at least 30 minutes a day. Exercise helps burn excess fat for energy. This also reduces the likelihood you’ll have fatty liver disease. Even if you feel like you don’t have 30 minutes to spare, try breaking up exercise into two 15-minute sessions or three 10-minute sessions.
- Don’t smoke. Smoking contains toxins that can injure your liver cells and most other cells in your body. Quitting can be very difficult, but a doctor can help you create a plan that’s right for you.
- Limit alcohol consumption. If you drink, one drink a day for women and no more than two drinks a day for men is a moderate, liver-friendly amount. If you already have a condition that affects your liver function, a doctor may suggest that you not drink at all.
- Avoid toxins. Chemicals like cleaning products, aerosols, insecticides, and additives all contain toxins that can damage your liver. Take proper safety precautions, such as wearing a mask and gloves, and use them in a ventilated area.
- Protect against hepatitis. Hepatitis B and C are two forms of liver disease that can cause chronic damage. They’re usually transmitted sexually or from sharing needles with a person who has these conditions.
- Don’t mix drugs and alcohol. The liver filters many medications, as well as alcohol. Combining the two can place too much demand on your liver and lead to damage. If you take a lot of medications, including supplements, it’s a good idea to review the list with a doctor to ensure you’re not overdoing it.
- Get vaccinated. There are vaccines available for hepatitis A and hepatitis B. They can help protect you and your liver.
If you have more questions about keeping your liver healthy, talk to a doctor.
The liver is an important organ that grows as you age. If the liver is enlarged, a doctor may perform various imaging studies and other tests to determine an underlying cause. If you’re concerned that your symptoms are the result of liver enlargement, talk to a doctor.
Normal Liver Size and Your Health
Your liver grows as you age, though certain health conditions, including acute hepatitis and fatty liver disease, can cause an enlarged liver. A large liver doesn’t always cause symptoms.
The liver is the body’s largest and heaviest internal organ. It serves many important purposes, including regulating levels of chemicals in the blood, making bile to digest fats, and making cholesterol, blood plasma proteins, and immune factors.
In adults, the liver weighs a little more than 3 pounds.
As you age, the liver varies in size, and certain health conditions can enlarge it.
Men tend to have a larger liver size than women. This is usually because men’s bodies tend to be larger. While liver sizes can vary slightly, there are some studies about the average liver size by age.
One such study was published in the journal Indian Pediatrics. The researchers performed ultrasound evaluation of 597 healthy children between the ages of 1 and 12 years.
The following are the results of the study measuring the average liver length for boys:
| Age | Liver length (Boys) |
| 1 to 3 months | 2.6 in. (6.5 cm) |
| 3 to 6 months | 2.8 in. (7.1 cm) |
| 6 to 12 months | 3.0 in. (7.5 cm) |
| 1 to 2 years | 3.4 in. (8.6 cm) |
| 2 to 4 years | 3.5 in. (9.0 cm) |
| 4 to 6 years | 4.1 in. (10.3 cm) |
| 6 to 8 years | 4. 3 in. (10.8 cm) |
| 8 to 10 years | 4.7 in. (11.9 cm) |
| 10 to 12 years | 5.0 in. (12.6 cm) |
The following are the results for liver length in girls:
| Age | Liver length (Girls) |
| 1 to 3 months | 2.4 in. (6.2 cm) |
| 3 to 6 months | 2.8 in. (7.2 cm) |
| 6 to 12 months | 3.1 in. (7.9 cm) |
| 1 to 2 years | 3.3 in. (8.5 cm) |
| 2 to 4 years | 3.5 in. (8.9 cm) |
| 4 to 6 years | 3.9 in. (9.8 cm) |
| 6 to 8 years | 4.3 in. (10.9 cm) |
| 8 to 10 years | 4.6 in. (11.7 cm) |
| 10 to 12 years | 4.8 in. (12.3 cm) |
Liver size can vary by sex, body mass index, height, amount of alcohol consumed, and many other factors.
An older study published in the Journal of Ultrasound in Medicine measured the average liver diameter of more than 2,080 male and female participants between 18 and 88 years old at the midclavicular line, which is an imaginary line moving down your body starting from the middle of your collarbone.
The study’s results found the following:
| Age | Average liver diameter |
| 18 to 25 years | 5.4 in. (13.6 cm) |
| 26 to 35 years | 5.4 in. (13.7 cm) |
| 36 to 45 years | 5.5 in. (14.0 cm) |
| 46 to 55 years | 5.6 in. (14.2 cm) |
| 56 to 65 years | 5.7 in. (14.4 cm) |
| Greater than 66 years | 5.6 in. (14.1 cm) |
The study represents one of the largest populations studied regarding average liver length, and it concluded that the average liver size in adults was 5.5 inches (in.), or 14 centimeters (cm).
Doctors use imaging studies to estimate liver size. Sometimes, when the liver is extremely enlarged, a doctor can identify the enlargement on an X-ray. When they want greater accuracy, they’ll usually use ultrasound.
Ultrasound is a painless imaging technique that uses sound waves to compare solid organs with other surroundings, such as blood.
Because ultrasound uses sound waves, it doesn’t expose a person to radiation, like many imaging techniques do.
Typically, a person who specializes in ultrasound, known as an ultrasonographer, or a liver doctor will perform the ultrasound. You’ll lie down, and they’ll use a special wand device to transmit images of the liver to an ultrasound screen. The size of the liver is measured on the screen.
The liver isn’t a proportional organ. Its lobes are different sizes and can be larger and smaller in areas depending on where the ultrasound professional is taking measurements. These differences can cause some variance accuracy. A doctor will also usually compare these results with other imaging studies, which may include a CT scan.
The condition of having an enlarged liver is called hepatomegaly. When the liver gets larger, it doesn’t always cause symptoms. Some people may report a feeling of abdominal fullness or pressure.
A variety of medical conditions can cause an enlarged liver.
Acute hepatitis
Acute hepatitis is inflammation of the liver caused by one of the five hepatitis viruses. The body may clear the virus or a person can develop chronic hepatitis, such as hepatitis B or hepatitis C.
Biliary atresia
Biliary atresia is a rare condition that affects the size or presence of the bile ducts. It often requires surgery to treat.
Cirrhosis
Cirrhosis can be the result of chronic alcohol consumption, hepatitis, or other liver-related conditions. Treatments for cirrhosis slow the progression of further scarring.
Fatty liver
Fatty liver is a condition that can occur due to heavy alcohol use or having more weight. It can be reversed in early stages with weight loss and abstaining from alcohol.
Infectious mononucleosis
Infectious mononucleosis is a viral disease caused by the Epstein-Barr virus. Many people will feel better in 2 weeks to several months.
Liver cancer
Various cancers can affect the liver.
Treatments depend on the cancer type but may include surgery and radiation.
Right heart failure
Right heart failure can cause excess fluid to build up in the liver’s blood vessels. Treatments usually aim to reduce fluid buildup and improve heart function in this serious heart failure side effect.
Additionally, rare diseases like Gaucher’s disease, Wilson’s disease, or Niemann-Pick disease can cause liver enlargement. Treatments for these diseases depend on the condition.
If you have an enlarged liver, your doctor will likely consider your overall symptoms, medical history, and imaging and blood studies before making a diagnosis.
Because your liver is so vital to your health, you should do the following to maintain good liver health:
- Maintain a healthy weight for you. Having more weight can lead to a condition called non-alcoholic fatty liver disease.
- Exercise at least 30 minutes a day. Exercise helps burn excess fat for energy. This also reduces the likelihood you’ll have fatty liver disease. Even if you feel like you don’t have 30 minutes to spare, try breaking up exercise into two 15-minute sessions or three 10-minute sessions.
- Don’t smoke. Smoking contains toxins that can injure your liver cells and most other cells in your body. Quitting can be very difficult, but a doctor can help you create a plan that’s right for you.
- Limit alcohol consumption. If you drink, one drink a day for women and no more than two drinks a day for men is a moderate, liver-friendly amount. If you already have a condition that affects your liver function, a doctor may suggest that you not drink at all.
- Avoid toxins. Chemicals like cleaning products, aerosols, insecticides, and additives all contain toxins that can damage your liver. Take proper safety precautions, such as wearing a mask and gloves, and use them in a ventilated area.
- Protect against hepatitis. Hepatitis B and C are two forms of liver disease that can cause chronic damage. They’re usually transmitted sexually or from sharing needles with a person who has these conditions.
- Don’t mix drugs and alcohol. The liver filters many medications, as well as alcohol. Combining the two can place too much demand on your liver and lead to damage. If you take a lot of medications, including supplements, it’s a good idea to review the list with a doctor to ensure you’re not overdoing it.
- Get vaccinated. There are vaccines available for hepatitis A and hepatitis B. They can help protect you and your liver.
This also reduces the likelihood you’ll have fatty liver disease. Even if you feel like you don’t have 30 minutes to spare, try breaking up exercise into two 15-minute sessions or three 10-minute sessions.
Hepatitis B and C are two forms of liver disease that can cause chronic damage. They’re usually transmitted sexually or from sharing needles with a person who has these conditions.If you have more questions about keeping your liver healthy, talk to a doctor.
The liver is an important organ that grows as you age. If the liver is enlarged, a doctor may perform various imaging studies and other tests to determine an underlying cause. If you’re concerned that your symptoms are the result of liver enlargement, talk to a doctor.
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Burkov S.G. • Abdominal ultrasonography
Ultrasound machine HS40
Top seller in the high class. High definition 21.5″ monitor, advanced cardio package (Strain+, Stress Echo), OB/GYN 3D expert capabilities (STIC, Crystal Vue, 5D Follicle), high density transducers.
- Test Method
- Liver
- Gallbladder and bile ducts
- Pancreas
- Spleen
- Esophagus, stomach, intestines
- Kidneys and Bladder
- Abdominal vessels
Examination Method
Ultrasound of the abdominal organs is performed in the morning on an empty stomach after an overnight fast, however, in emergency situations, the study can be performed at any time.
In most cases, special preparation is not required, although in obese patients, patients with severe flatulence, a qualitative examination may be difficult. To reduce interference caused by the presence of gas in the intestines, it is recommended to follow a diet poor in fiber for 2-3 days, and exclude foods that increase gas formation in the intestines from food. In addition, the reception of carbolen, enzyme preparations (festal, digestal) is indicated. There is no need for a cleansing enema. When examining on an emergency basis, as well as after eating, it is necessary to remember the possibility of detecting additional inclusions in the stomach or intestines due to the presence of contents in their lumen.
Ultrasound is performed with the patient lying on his back, left and right side, sitting or standing, while it is desirable to adhere to the following sequence: the examination begins with the upper abdomen with longitudinal sections. The transducer is placed in the epigastrium along the midline.
In this position, the left lobe of the liver and behind it the abdominal aorta are visualized. Then the transducer is shifted to the left, examining the rest of the left lobe. After that, the sensor is sequentially moved in the opposite direction, along the right hypochondrium to the anterior axillary line. At the same time, the transition of the left lobe to the right, the region of the round ligament of the liver, the caudate and square lobes, the inferior vena cava, the right lobe of the liver, the liver veins, the portal vein, the gallbladder, the right kidney are visualized. Then the longitudinal sections are repeated, moving the sensor again to the left to the midline. After that, scanning is carried out in the transverse plane: the transducer is installed at the level of the xiphoid process and successive sections are made, moving it to the navel and back. In this case, the left lobe of the liver, stomach, pancreas, aorta, inferior vena cava, celiac trunk, superior mesenteric artery, splenic vein are visualized.
Scheme 1. Algorithm for performing ultrasound examination of the abdominal organs (longitudinal scanning):
a) – scanning from the midline of the abdomen to the left;
b) – scanning from the left anterior axillary line to the right anterior axillary line;
c) – scanning from the right anterior axillary to the midline.
The study is carried out without holding the breath. As a result of the scan in 2 planes, a general idea of the topography of the organs of the upper floor of the abdominal cavity is obtained and gross deviations from the norm are revealed (schemes 1, 2).
Scheme 2. Algorithm for performing ultrasound examination of the abdominal organs (transverse scanning):
a) – scanning from the xiphoid process to the navel;
b) – scanning from the navel in the cranial direction.
Then proceed to a detailed study of the organs while holding the breath at the height of a deep breath. When examining the liver and gallbladder, the transducer is set parallel to the right costal arch and its slight inclinations, the entire liver and gallbladder are viewed. With severe flatulence, it is possible to conduct a study through the intercostal spaces on the right in the position of the patient on the left side, which will avoid interference caused by swollen intestinal loops. Sonography of the pancreas begins with transverse sections, subsequently moving to scanning in the longitudinal plane. The spleen is examined in the position of the patient on the right side, placing the transducer perpendicular to the costal arch.
To examine the gastrointestinal tract, first longitudinal sections are made along the entire abdomen from left to right and back, then transverse sections from top to bottom and back. Both the stomach and intestines should be examined in the transverse and longitudinal planes.
Ultrasound examination of the kidneys is carried out both from the back (transverse and longitudinal sections), and from the front (lying on the back) and lateral (lying on the right and left side) surfaces of the abdomen, better when holding the breath in the phase of deep inspiration. To detect mobility or prolapse of the kidneys, echography is performed with the patient sitting or standing.
The proposed algorithm for ultrasound examination of the abdominal organs and kidneys must be followed in all cases, since only a systematic analysis of the obtained echograms allows a full-fledged examination, avoiding possible errors, and obtaining the necessary information. It should be remembered that the quality of the examination, first of all, depends on the attention of the doctor, and a hasty examination is unacceptable.
Liver
Liver ultrasound can be performed at any time without prior preparation. The examination is carried out, as a rule, in three planes (longitudinal, transverse and oblique) from the side of the right hypochondrium and epigastrium.
In this case, it is necessary to assess the location, shape, contours, dimensions, structure and echogenicity of the parenchyma, the vascular pattern in general and specific vessels, the ductal system, the influence of surrounding organs on the state of the liver image. The accuracy of diagnosing the detected changes increases with dynamic observation (Scheme 3).
Diagram 3. Liver scan transducer positions:
1-3 – subcostal scan
4 – longitudinal scan
5 – transverse scan
6-7 – intercostal.
Normally, most of the liver is located to the right of the spine, and the smaller part is to the left of it and reaches the left parasternal line. The contours of the liver are even, it has a clear outline, the capsule is clearly visible in the form of a hyperechoic structure surrounding its parenchyma (with the exception of areas adjacent to the diaphragm, where the capsule is not differentiated from the latter).
Normally, the lower edge of the liver does not protrude from under the costal arch. Generally accepted are the measurement of the oblique vertical size of the right lobe (does not exceed 13-15 cm) and the thickness of the left lobe (up to 5 cm). The structure of the unchanged liver is represented by a fine-grained image, consisting of many small dotted and linear structures, evenly spaced over the entire area of the obtained section. In terms of echogenicity, the parenchyma of a normal liver is comparable or slightly higher than the echogenicity of the cortical substance of the kidney (in the absence of its pathology). Sonography allows differentiation of various tubular structures found in the liver.
A distinctive feature of the hepatic veins is their radial location (from the periphery to the center), the “absence” of walls, the ability to trace the course of small branches (up to 1 mm in diameter) to the periphery of the organ. The portal vein is formed by the confluence of the superior mesenteric and splenic veins.
It is best seen with an oblique scan through the right hypochondrium and is visualized as a tubular structure with clear walls. It can be traced from the place of formation to the confluence with the portal of the liver, where it is divided into left and right branches. Normally, the diameter of the portal vein does not exceed 13-15 mm. The hepatic artery is visualized in the region of the liver gate as a tubular structure of small diameter (up to 4-6 mm) with highly echogenic walls. Normal intrahepatic bile ducts can only be visualized starting from the lobar. They also have highly echogenic walls and a small diameter (less than 1 mm).
Research results
1. Sonographic picture of normal left and right lobes of the liver.
Fig. 2. One of the variants of the echogram of the normal liver parenchyma.
Fig. 3. Sonographic picture of the image of the lobar hepatic duct.
Fig. 4. Echogram of the right lobe of the liver with its enlargement: Liver – liver, Kidney – kidney.
Fig. 5. Echographic picture of fatty infiltration of the liver – increased echogenicity of the parenchyma with the effect of weakening in the deep sections of the liver.
Fig. 6. Sonographic picture of a focal form of fatty infiltration (marked with arrows).
Fig. 7. Echographic picture of one of the variants of decompensated cirrhosis of the liver: 1 – ascites, 2 – gallbladder, 3 – liver.
Fig. 8. Sonographic picture of porto-caval anastomoses in the hilum of the liver: 1 – liver, 2 – gallbladder, 3 – porto-caval anastomoses, 4 – liver cyst.
Fig. 9. Echographic picture of one of the variants of the image of the capillary hemangioma of the left lobe of the liver.
Fig. 10. Echographic picture of a simple salitary cyst of the right lobe of the liver (marked with markers).
Fig. 11. Echographic picture of polycystic liver disease.
Fig. 12. Echographic picture of small calcification of the liver (marked with an arrow).
Fig. 13. Sonographic picture of multiple liver metastases: M – metastases.
Gallbladder and bile ducts
Echography of the gallbladder and bile ducts must be performed on an empty stomach, not earlier than 8-12 hours after a meal. This is necessary for sufficient filling of the bladder with bile. The patient is examined in three positions – in the supine position, on the left side, standing, at the height of a deep breath. Normally, the gallbladder is located on the dorsal surface of the liver, it distinguishes the bottom, body and neck, which passes into the cystic duct. With longitudinal scanning, the gallbladder is located as an echo-negative oval, elongated or pear-shaped formation, from 4 to 9.5 cm, up to 3-3.5 cm wide, with thin (up to 1.5-2 mm) walls. Normally, the contents of the bladder are homogeneous, homogeneous (Scheme 4).
Scheme 4. Probe position during gallbladder scanning.
1.3 – in the supine position;
2.
4 – in the position on the left side.
Intrahepatic bile ducts run parallel to the branches of the portal vein, located ventrally from them. Small bile ducts (normally practically invisible) merge into larger ones in the direction of the liver gate, forming the right and left hepatic ducts, which merge at the liver gate into the common hepatic duct (normally its diameter does not exceed 4-5 mm).
Scheme 5. Anatomy of the gallbladder and bile ducts.
The latter, connecting with the cystic duct, forms the common bile duct (normally its diameter does not exceed 7 mm), which opens into the duodenum 12. The ducts have even, clear walls, the lumen is free from echo signals (Scheme 5).
Research results
Fig. 14. Sonographic picture of a normal gallbladder.
Fig. 15. Echographic picture of a deformed gallbladder.
Fig. 16. Echographic picture of cholesterosis of the gallbladder (cholesterol polyps are marked with arrows).
Fig. 17. Echographic picture of putty-like bile in the cavity of the gallbladder, resembling a solid formation (marked with an arrow).
Fig. 18. Echographic picture of one of the variants of gallstone disease – multiple small (1-2 mm) floating calculi in the cavity of the gallbladder.
Fig. 19. Echographic picture of one of the variants of cholelithiasis (two “soft” cholesterol calculi are marked with arrows).
Fig. 20. Echographic picture of one of the variants of cholelithiasis – a calculus 1.9 cm in size, giving an acoustic shadow.
Fig. 21. Echographic picture of one of the variants of cholelithiasis – disabled gallbladder. In the projection area of the gallbladder, a conglomerate of dense echo structures (marked with an arrow) is visualized, giving an acoustic shadow behind it.
Fig. 22. Echographic picture of one of the variants of the image of the gallbladder during exacerbation of chronic cholecystitis (thickening and layering of the wall).
Fig. 23. One of the variants of the complicated course of the postoperative period is an infiltrate (circled by the cursor) in the area of the gallbladder bed after its removal.
Fig. 24. One of the complications of cholecystectomy surgery is a small calculus is visualized in the gallbladder stump (marked by arrows), giving an acoustic shadow.
Fig. 25. Echographic picture of choledocholithiasis (a calculus giving an acoustic shadow is marked with an arrow).
Fig. 26. Echographic picture of dilated choledochus (diameter 21 mm) after cholecystectomy: 1 – choledochus, 2 – stomach, 3 – dilated duct of Wirsung, 4 – portal vein, 5 – superior mesenteric artery, 6 – aorta.
Pancreas
Ultrasound of the pancreas is performed at the height of forced inspiration or with an inflated abdomen, when the left lobe of the liver descends significantly into the abdominal cavity, being a good environment for ultrasound.
In some cases, for better visualization of the gland, it is possible to recommend the patient to drink 300-500 ml of warm, degassed water in small sips, thereby creating an acoustic window.
When examining the pancreas, first a transverse and then a longitudinal scan is performed. Transverse scanning is carried out approximately at an angle of 10-20° along a conditional line drawn from the hilum of the right kidney to the hilum of the spleen or the upper pole of the left kidney, by successively shifting the transducer from the xiphoid process towards the umbilicus. Longitudinal scanning is performed by sequentially moving the sensor from the right midclavicular line to the left anterior axillary line. The main anatomical landmarks for identifying the pancreas: the splenic vein, located under the lower edge of the gland, the superior mesenteric artery – a round anechoic formation below the vein, and even lower and to the left – a round anechoic formation – the aorta, and to the right and below – an anechoic oval formation – the lower hollow vein (scheme 6).
Chart 6. Pancreas scan transducer positions:
a) – transverse scanning;
b) – longitudinal scanning.
In its echogenicity, the pancreas either approaches the internal structure of the liver, or slightly exceeds it. The parenchyma of the gland in most cases is homogeneous, but in some cases it can be fine-grained. With age and in obese people, the echogenicity of the gland gradually increases. Determination of the size of the gland is of paramount importance for the diagnosis of its various diseases. Thickness, i.e. the anterior-posterior size of the head is 2.5-3.0 cm, the body -1.5-1.7 cm and the tail up to 2.0 cm. Normally, the Wirsung duct can also be visualized, its diameter in the body of the gland in healthy individuals does not exceed 1 mm, and in the head – 2 mm.
Research results
27. One of the variants of the echographic image of the anatomy and topography of the normal pancreas: 1 – liver, 2 – head, 3 – body, 4 – tail of the pancreas, 5 – portal vein, 6 – splenic vein, 7 – superior mesenteric artery, 8 – inferior vena cava, 9 – aorta.
Fig. 28. Sonographic picture of a pancreatic pseudocyst: 1 – liver, 2 – stomach, 3 – cyst.
Fig. 29. Sonographic picture of a pancreatic tumor: Hepar – liver, Pancreas – pancreas, Tumor – tumor, V.p. – portal vein, AMS – superior mesenteric artery, Aorta – aorta.
Spleen
Ultrasonography of the spleen is best performed at a high inspiratory depth with the patient in the right lateral position. Its outer surface is slightly convex, the inner surface is slightly concave, while it looks like a crescent, the long axis of which is directed from top to bottom and forward. Sometimes the spleen is covered by the lungs and is not visualized. In this case, a study is proposed through the intercostal spaces on the left, in which the obtained ultrasound image is similar to the image of the organ along the long axis. On the inner surface of the spleen, its gate is visualized – the place where the artery and vein enter the parenchyma. The parenchyma of the spleen has the appearance of a homogeneous formation with a fine-grained internal structure, its echogenicity is significantly lower than the echogenicity of the liver and slightly higher than the kidney parenchyma.
Normally, the length of the spleen does not exceed 11-12 cm, thickness – 4-5 cm, area – 50 sq. cm. The diameter of the splenic vein in the region of the gate is 5-7 mm (Scheme 7).
Scheme 7. Probe position for spleen scan:
1-2 – transverse scanning;
3 – longitudinal scanning.
Research results
Fig. 30. Echographic picture of a normal spleen.
Fig. 31. Sonographic picture of the accessory spleen.
Fig. 32. Echographic picture of the enlarged spleen in liver cirrhosis (1), dilated splenic (2) and gastric (3) veins.
Fig. 33. Sonographic picture of a spleen cyst: C – spleen, K – cyst, S.V. – splenic vein.
Fig. 34. Echographic picture of spleen infarction (marked with an arrow).
Esophagus, stomach, intestines
Ultrasound of the esophagus and stomach is performed on an empty stomach, and the intestines are better after defecation.
The position of the patient can be different and is chosen taking into account the possible localization of the pathological process and its best visualization. On the sagittal section passing through the esophageal opening of the diaphragm (the transducer is installed in the epigastrium under the xiphoid process), the normal esophagus is located as a tubular structure formed by two anechoic strips corresponding to the anterior and posterior walls of the esophagus, and a hyperechoic central zone enclosed between them, corresponding to its mucous membrane. The diameter of the esophagus is measured from its anterior to posterior wall (outer-outer size) along a plane perpendicular to the axis of the esophagus, and does not normally exceed 10.5 mm. The length of the abdominal esophagus in healthy individuals is 15-20 mm.
Ultrasound examination of the stomach is carried out in the epigastrium in longitudinal and transverse sections. The thickness of the stomach wall is normally 3-7 mm, in some cases it is possible to visualize 5 layers of its wall (the first is echogenic, corresponds to the mucosa; the second is anechoic – the muscular plate of the mucosa; the third is echogenic – submucosal; the fourth is anechoic – muscular and fifth – echogenic – serous membranes) and trace peristaltic contractions.
The echographic picture of the small and large intestines is largely similar, the wall thickness of both is normally 2-5 mm, depending on the peristalsis and the degree of distension. The main ultrasound sign of a lesion of the stomach or intestines is a thickening of their walls, the appearance of the so-called pseudo-kidney symptom (damage to a hollow organ).
Research results
35. Sonographic picture of the unchanged abdominal esophagus: 1 – liver, 2 – abdominal esophagus, 3 – heart, 4 – diaphragm.
Fig. 36. Sonographic picture of hypersection of the stomach, 5 layers of the wall are visible: St. – stomach, G.B. – gallbladder.
Fig. 37. Echographic picture of one of the variants of the body of the stomach and metastatic liver damage: 1 – thickened up to 17 mm wall of the stomach, 2 – liver, 3 – metastasis.
Fig. 38. Echographic picture of colon cancer and liver metastases: M – metastases, TK – thickened intestinal wall.
Kidneys and Bladder
Since the upper segment of the kidneys is covered by the ribs, to reduce the interference caused by them, echography is performed from the back (anterior and lateral surfaces of the abdomen) while holding the breath in the deep inspiration phase. With a high location of the kidneys, as well as to determine their mobility, scanning is carried out in the vertical position of the patient. To determine the position of the kidneys, a series of transverse scans is initially performed (from the back in the prone position), sequentially moving the transducer from the lower pole to the upper one. Longitudinal scanning is carried out by shifting the sensor from the outer surface of the kidneys to the inner one. To get a more accurate idea of the state of the parenchyma, the size of the pelvis and to determine the vessels, the study is also carried out from the side of the anterior surface of the abdomen. On longitudinal sections, the kidney is visualized as an elongated oval, and on transverse sections, as an ovoid formation, clearly differentiated from the surrounding tissues.
Normally, the length of the kidney is 7.5-12.0 cm, the width is 4.5-6.5 cm, and the difference in the length of both kidneys does not exceed 1.5-2.0 cm (Scheme 8).
Diagram 8. Probe position for kidney scan:
1 – longitudinal scanning;
2 – transverse scanning.
The kidney parenchyma has a very delicate, almost anechoic internal structure. Between the kidney capsule and the pelvicalyceal system, especially in young and middle-aged people, one can see multiple almost round-shaped echo-negative formations, which are pyramids. The diameter of the pyramids ranges from 0.5 to 0.9see Cup complex is detected as a formation of increased echogenicity, located in the center of the kidney. Normally, the ratio of the renal parenchyma to the cup complex is approximately 2:1.
The bladder is examined from the anterior abdominal wall. A necessary condition is its good filling, since an empty bladder is not determined by sonography.
Moreover, the more fluid in the bubble, the more reliable the results will be. Normally, an unchanged bladder on transverse sections is visualized as an echo-negative barrel-shaped formation, and on longitudinal sections – as an echo-negative ovoid formation, clearly defined, with a smooth and smooth surface, free from internal structures.
Research results
39. Echographic picture of normal right (R.K.) and left (L.K.) kidneys.
Fig. 40. Echographic picture of a simple uncomplicated cyst (K) of the left kidney.
Fig. 41. Echographic picture of polycystic kidney disease (the left kidney is circled with the cursor).
Fig. 42. Echographic picture of the left and right kidneys with small angiomyolipomas in the parenchyma.
Fig. 43. Echographic picture of a kidney with a calculus in the neck of the calyx with symptoms of its obstruction and hydrocalicosis (arrow).
Fig. 44. Sonographic picture of a kidney with a calculus in the pelvis: 1 – kidney, 2 – calculus, 3 – acoustic shadow.
Fig. 45. Echographic picture of a kidney with a dilated pelvis (indicated by arrows).
Fig. 46. Echographic picture of the kidney with dilatation of the pelvis and proximal ureter: 1 – bladder, 2 – ureter, 3 – kidney, 4 – pelvis.
Fig. 47. Echographic picture of a normal bladder (the ejection of a stream of urine from the mouth of the left ureter is indicated by an arrow).
Fig. 48. Sonographic picture of bladder diverticulum: 1 – bladder, 2 – diverticulum.
Abdominal vessels
Ultrasound of abdominal vessels is performed through the anterior abdominal wall at the height of deep inspiration and with free breathing. Ultrasound examination makes it easy to locate most of the main vessels: aorta, celiac trunk, superior mesenteric, hepatic and splenic arteries, inferior vena cava, portal, splenic, superior mesenteric and right renal veins. Their visualization is important, since the main vessels are a kind of “road map”, the use of which allows you to determine the location of organs and other anatomical formations of the abdominal cavity, in some cases correctly assess the severity of the pathological process in the organ, and also diagnose various injuries and diseases of the vessels.
On longitudinal scans, the abdominal aorta looks like a pulsating tubular structure located slightly to the left or above the spine, somewhat narrowing in the caudal direction, formed by two echopositive linear structures with an echo-negative central zone. The normal aortic diameter is 2.0-2.5 cm. The inferior vena cava has the appearance of a similar tubular structure with clearly defined walls, located somewhat to the right of the spine, the largest diameter, which changes with straining (!), does not exceed 2.5 cm in normal .
Research results
49. Echographic picture of the longitudinal section of the aorta (1), superior mesenteric (2) and celiac (3) arteries.
Fig. 50. Echographic picture of the cross section of the aorta, celiac artery and its branches: 1 – aorta, 2 – celiac artery, 3 – hepatic artery, 4 – splenic artery, 5 – portal vein, 6 – inferior vena cava, 7 – spine.
Fig. 51. Ultrasound picture of the abdominal aorta in the area of bifurcation (marked with an arrow).