Protocoling Imaging Studies: Complete Abdominal Ultrasound (Ultrasound Abdomen Complete)

OVERVIEW

This page covers the important aspects of how to protocol (i.e. conduct) a complete abdominal ultrasound. This is a very commonly conducted study that has a clear protocol in place that will ensure all the proper images are taken. The various components of the study are outlined more below in detail, with example images.

An abdominal ultrasound is an important radiological study that generally has a fairly clear protocol. It is outlined more on this page below (image source).
SUMMARY OF IMAGES/CLIPS THAT ARE NEEDED

Pancreas

  • Transverse view: image of head, body, and tail if possible. Clip of entire pancreas.

Aorta

  • Sagittal view: 2-3 images showing length of aorta from liver to bifurcation. Often times proximal, mid, and distal images are taken.
  • Transverse view: image showing mid-abodminla aorta and bifurcation of aorta. Clip of aorta bifurcating into the common illiacs.

Inferior Vena Cava (IVC)

  • Sagittal view: one image of inter hepatic vessel, one image of entire length inferior to liver.
  • Transverse view: image showing the entering of hepatic veins to the

Left Lobe Liver

  • Sagittal view: medial, mid, and lateral sections of liver lobe. Clip of entire liver lobe.
  • Transverse view: superior, mid, and inferior sections of liver lobe. Clip of entire liver lobe.

Right Lobe Liver

  • Sagittal view: medial, mid, and lateral sections of liver lobe. Clip of entire liver lobe.
  • Transverse view: superior, mid, and inferior sections of liver lobe. Clip of entire liver lobe.

Gallbladder

  • Long axis view: still image showing this axis. Clip of entire organ in this axis.
  • Short axis  view: still image showing this axis. Clip of entire organ in this axis.

Common Bile Duct

  • Still image showing common bile duct and portal vein

Right Kidney

  • Sagittal view: long axis of organ measured with calipers. Clip showing entire long axis of kidney.
  • Transverse view: images of upper pole, mid pole, and lower pole. Clip showing entire kidney through this view.

Left Kidney

  • Sagittal view: long axis of organ measured with calipers. Clip showing entire long axis of kidney.
  • Transverse view: images of upper pole, mid pole, and lower pole. Clip showing entire kidney through this view.

Spleen

  • Sagittal view: long axis of organ measured with calipers and clip of as much of organ as possible.
  • Transverse view: still image in this view, and clip showing as much of organ as possible.
PANCREAS (TRANSVERSE VIEW)

The first organ to begin with for this exam is the pancreas. This is because the pancreas can easily become “gassed” out during later parts of the exam. All images of this organ will be acquired in the transverse orientation. The goal is to acquire still images of the head, body, and tail (if possible) for this organ, as well as a clip that scans through its entirely.

HEAD OF THE PANCREAS

For the head of the pancreas, it is useful to try and find the gastro-duodenal artery (GDA) and the common bile duct (CBD) in the transverse image (which serve as landmarks for the head of the pancreas). A still image of the head of the pancreas should be taken (such as the example shown below) that demonstrates the important landmarks needed to identify it as the true head of the pancreas.

The above images are trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the head of the pancreas (outlined in red) as well as other anatomical regions of interest.

BODY OF THE PANCREAS

The body of the pancreas can be found by following the head of the pancreas more towards the left side of the patient. The portal confluence can still be appreciated when a still image is taken of the body of the pancreas (which is shown in the image below).

The above images are trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the body of the pancreas (outlined in red) as well as other anatomical regions of interest.

TAIL OF THE PANCREAS

The tail of the pancreas can sometimes by challenging to find, and a still image can not always be acquired easily.

CLIP OF THE ENTIRE PANCREAS

After taking the above still images have been saved, a clip should be acquired that shows as much of the pancreas as possible. An example is seen below:

The above clip is from a trans-abdominal ultrasound taken with the probe in the transverse orientation. It helps show the pancreas.
THE AORTA (SAGITTAL VIEW)

Next the aorta will be imaged in the sagittal plane. The goal will be to acquire still images that show the entire length of the aorta from the liver down to the bifurcation. Generally 2-3 images will be needed to do this.

PROXIMAL AORTA

The proximal aorta can be seen running alongside the liver. In some cases the celiac artery and the superior mesenteric artery (SMA) can be seen nearby/coming off of it. The image below shows an example of this image that should be aquired.

The above images are trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the proximal aorta (outlined in red) as well as other anatomical regions of interest.

MID AORTA

The mid aorta can be seen lower on the abdomen. In some cases the celiac artery and the superior mesenteric artery (SMA) can be seen nearby/coming off of it. The image below shows an example of this image that should be aquired.

The above images are trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the mid aorta of  (outlined in red) as well as other anatomical regions of interest.

DISTAL AORTA

The distal aorta can be seen lower on the abdomen. The purpose of this image is to try and image the aorta right as it bifurcates into the common iliac arteries. It is important to note that sometimes showing the iliac arteries and the aurora in the same plane/still image can be challenging. An example of this image is shown below.

The above images are trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the distal aorta (outlined in red) and the banging of the bifurcation into the common iliac arteries is pointed out as well.
THE AORTA (TRANSVERSE VIEW)

Next the aorta will be imaged in the transverse plane. The goal will be to acquire a still image that shows the mid-abodminal aorta, and a clip of the bifurcation of the aorta into the common iliac arteries.

MID-ABDOMINAL AORTA

A still image of the abdominal aorta can be acquired and saved. An example is shown below.

The above images are trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the mid-abdominal aorta (outlined in red).

BIFURCATION OF AORTA

A clip is also taken that shows the bifurcation of the aorta into the common iliac arteries. An example is shown below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the transverse orientation. It helps show the bifurcation of the distal aorta into the common iliac arteries.
THE IVC (SAGITTAL VIEW)

The next thing to image will be the IVC in the sagittal plane. The goal here is to try and show the entire length of the structure starting from the inter hepatic portion of the vessel. This is commonly done by taking two still images, one of the inter-hepatic portion of the IVC and one showing as much of the entire length inferior to the liver.

INTER-HEPATIC PORTION OF IVC

By scanning the right lobe of the liver, it should be possible to locate the portion of the IVC that courses through the liver. This image should be saved to show that there is no thrombus in this portion of the vessel. An example of this image is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the inter-hepatic portion of the IVC (outlined in red) that is free of any thrombus.

ENTIRE LENGTH OF IVC

By traveling more inferiorly, the entire length of the IVC should try to be captured on a still image. The the image below shows an example of this.

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show most of the length of the IVC (outlined in red).
THE IVC (TRANSVERSE VIEW)

The IVC can also be appreciated in the transverse view. Only one image is needed from this view, one that shows the liver at the level of where the hepatic veins connect to the IVC (as shown in the example below).

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the IVC and where the hepatic veins connect to it.
LEFT LIVER LOBE (TRANSVERSE VIEW)

The next organ to focus on will be the liver. It becomes more manageable to scan the liver when it is split into lobes. The first lobe to image will be the left liver lobe in the transverse orientation. The goal of these scans is to capture still images that demonstrate the appearance leftmost, middle, and rightmost sections of the left liver lobe, and to also provide a video clip scanning through the entire left liver lobe.

SUPERIOR PORTION OF LEFT LIVER LOBE

A superior section of the left liver lobe should be imaged at the level of the left hepatic vein. An example of this is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the IVC and where the left hepatic vein connects to it. This image represents the superior aspect of the left liver lobe.

MIDDLE PORTION OF LEFT LIVER LOBE

By scanning lower on the left lobe of the liver, the left portal vein can be visualized and a still image can be taken at this level to document the appearance of the middle portion fo the left liver lobe. An example is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the left portal vein. This image represents the middle portion of the left liver lobe.

INFERIOR PORTION OF LEFT LIVER LOBE

Scanning even further towards the inferior aspect of this lobe, the ligamentum trees should be visualized, and a still image can be taken at this level to document the appearance of the inferior portion fo the left liver lobe. An example is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the ligamentum teres. This image represents the inferior portion of the left liver lobe.

CLIP OF LEFT LIVER LOBE

After the still images have been taken, a clip of the entire left liver lobe can be taken. An example is shown below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the transverse orientation. It helps show the entire left liver lobe.
LEFT LIVER LOBE (SAGITTAL VIEW)

The next thing to scan will be the left liver lobe in the sagittal orientation. The goal of these scans is to capture still images that demonstrate the appearance of the medial, middle, and lateral sections of the left liver lobe, and to also provide a video clip scanning through the entire left liver lobe.

MEDIAL PORTION OF LEFT LIVER LOBE

Scanning from the medial aspect of the liver, the leftmost portion of the left liver lobe can be appreciated. This will only include a small cross section of the liver, as seen in the example below.

The above image is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the most medial portion of the left liver lobe (outlined in red).

MIDDLE PORTION OF LEFT LIVER LOBE

By then scanning more laterally, the middle portion of the left liver lobe can be imaged as well. This will be a larger cross section compared to the lateral portion (as seen in the image below).

The above image is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the middle portion of the left liver lobe (outlined in red).

LATERAL PORTION OF LEFT LIVER LOBE

By then scanning even more laterally, the lateral portion of the left liver lobe can be imaged as well. This will be a larger cross section compared to the lateral portion (as seen in the image below).

The above image is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the lateral portion of the left liver lobe (outlined in red). The caudate lobe of the liver can also be seen (outlined in blue).

CLIP OF LEFT LIVER LOBE

After the still images have been taken, a clip of the entire left liver lobe can be taken. The An example is shown below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. It helps show the entire left liver lobe.
RIGHT LIVER LOBE (TRANSVERSE VIEW)

The next organ to focus on will be the liver. It becomes more manageable to scan the liver when it is split into lobes. The second lobe to image will be the right liver lobe in the transverse orientation. The goal of these scans is to capture still images that demonstrate the appearance of the superior, middle, and inferior sections of the right liver lobe, and to also provide a video clip scanning through the entire right liver lobe.

SUPERIOR PORTION OF RIGHT LIVER LOBE

The superior section of the right liver lobe should be imaged at the level of the left hepatic vein. An example of this is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the right hepatic vein. This image represents the superior aspect of the right liver lobe.

MIDDLE PORTION OF RIGHT LIVER LOBE

By scanning slightly lower on the patient the middle portion of the right liver lobe can be imaged. This image should be at the level of the portal vein (as shown in the example below).

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the right portal vein. This image represents the middle aspect of the right liver lobe.

INFERIOR PORTION OF RIGHT LIVER LOBE

By scanning even lower, the inferior aspect of the right liver lobe can be imaged. This image should include a portion of the right kidney. An example is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the location of the liver (outlined in red) and the right kidney (outlined in blue). This image represents the inferior aspect of the right liver lobe.

CLIP OF RIGHT LIVER LOBE

After the still images have been taken, a clip of the entire right liver lobe can be taken. This is the larger lobe of the liver, and may require multiple clips to be taken to transverse it (as seen below).

The above clip is from a trans-abdominal ultrasound images with the probe in the transverse orientation. It helps show the superior portion of the right liver lobe.
The above clip is from a trans-abdominal ultrasound taken with the probe in the transverse orientation. It helps show the inferior portion of the right liver lobe.
RIGHT LIVER LOBE (SAGITTAL VIEW)

The next thing to scan will be the right liver lobe in the sagittal orientation. The goal of these scans is to capture still images that demonstrate the appearance of the medial, middle, lateral inferior sections of the right liver lobe, and to also provide a video clip scanning through the entire right liver lobe.

MEDIAL PORTION OF RIGHT LIVER LOBE

Scanning from the medial aspect of the liver, the medial portion of the left liver lobe can be appreciated. An example is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the liver (outlined in red) and the right kidney (outlined in blue). This image represents the medial aspect of the right liver lobe.

MIDDLE PORTION OF RIGHT LIVER LOBE

By scanning more laterally, the middle portion of the right liver lobe can be imaged. An example is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the liver (outlined in red). This image represents the middle portion of the right liver lobe.

LATERAL PORTION OF RIGHT LIVER LOBE

By scanning even more laterally, the lateral portion of the right liver lobe can be imaged. An example is shown below.

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical however the image on the right has been annotated to show the location of the liver (outlined in red). This image represents the lateral portion of the right liver lobe.

CLIP OF RIGHT LIVER LOBE

After the still images have been taken, a clip of the entire right liver lobe can be taken. An example is shown below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. It helps show the entire right liver lobe.
GALLBLADDER ( PATIENT SUPINE)

The next organ to focus on will be the gallbladder. The gallbladder is imaged both when the patient is supine and in the left lateral decubitus (LLD) position. The goal will be to start with the patient supine and then take an image of the long axis (often sagittal) of the gall bladder, as well as a clip of it. Then the same will be done for the short axis of the gall bladder (often transverse) where a still image and clip is collected.

LONG AXIS OF THE GALLBLADDER

The gall bladder can be found inferior to the liver. A still image of the long axis of this organ should be taken similar to the example below.

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation with the patient supine. The images are identical however the image on the right has been annotated to show the long axis of the gallbladder (outlined in red). and a small gallstone.

CLIP OF ENTIRE GALLBLADDER IN LONG AXIS

After the still image is saved, a clip scanning through the entire long axis of the gallbladder can be taken as shown in the example below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation with the patient supine. It helps show the entire long axis of the gallbladder. A small gallstone can also be seen in the gallbladder.

SHORT AXIS OF THE GALLBLADDER

The short axis of the gallbladder should also be imaged as seen in the example below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the short axis of the gallbladder (outlined in red). and a collection of gallstones.

CLIP OF ENTIRE GALLBLADDER IN SHORT AXIS

After the still image is saved, a clip scanning through the entire short axis of the gallbladder can be taken as shown in the example below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. It helps show the entire short axis of the gallbladder.
GALLBLADDER ( PATIENT LLD)

After images of the gallbladder are taken in the supine position,  the same exact set of images/clips will be taken with the patient in the LLD position: still images of the organ in its long axis and short axis, and then corresponding clips as well. Examples for all of these images are omitted here (because they will be very similar to those shown in the previous section).

COMMON BILE DUCT

The next structure to image is the common bile duct (CBD). The exact orientation of the probe (sagittal, transverse, somewhere in between) may vary patient to patient. The common bile duct can be found above the portal vein, and can be more easily identified with the addition of color flow (as it is avascular/colorless and the portal vein is vascular/colorful). An example showing this is found below.

The above images are from a trans-abdominal ultrasound taken color flow. The images are identical however the image on the right has been annotated to show the common bile duct (CBD) that is right above the portal vein. The CBD does not have any color flow, however the portal vein does, making them easy to distinguish from one another.
RIGHT KIDNEY (SAGITTAL VIEW)

The next organ to focus on will be the right kidney in the sagittal plane. The goal will be to measure the kidney with calipers on its long axis, and to take a clip of the entire kidney in this plane.

LONG AXIS OF KIDNEY

The long axis of the kidney can be measured in the sagittal plane with calipers. An example of this is shown below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical except the right image has been annotated to show the boundaries fo the kidney (outlined in red), and the liver as a reference point. This image is marked with calipers that can calculate the size of the kidney.

CLIP OF LONG AXIS OF KIDNEY

After the still image is taken, a clip of the entire long axis of the kidney can be taken (as shown in the example below).

The above clip is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. It helps show the kidney along its long axis.
RIGHT KIDNEY (TRANSVERSE VIEW)

The right kidney can now be imaged in the transverse orientation. The goal will be to take still images of the upper pole, the mid pole, and the lower pole, as well as a clip that scans through the entire organ in this transverse orientation.

UPPER POLE OF KIDNEY

The upper pole of the kidney is located next to the liver parenchyma, as seen in the example below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the upper pole of the kidney (outlined in red) and the liver (outlined in blue).

MID POLE OF KIDNEY

The mid pole of the kidney is located lower, and sometimes the renal hilum can be seen as well, as shown in the example below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the mid pole of the kidney (outlined in red) and the renal hilum.

LOWER POLE OF KIDNEY

By scanning even more inferior, the lower pole of the kidney can be imaged, as shown in the example below.

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical however the image on the right has been annotated to show the lower pole of the kidney (outlined in red).

TRANSVERSE CLIP OF THE KIDNEY

After the still images are saved, a clip of the entire kidney in the transverse orientation can be saved like the example shown below.

The above clip is from a trans-abdominal ultrasound taken with the probe in the transverse orientation. It helps show more of the kidney in the this orientation.
LEFT KIDNEY (SAGITTAL & TRANSVERSE VIEWS)

The left kidney can be imaged in the exact same way as the right kidney. For this reason example images are omitted below.

SPLEEN (SAGITTAL VIEW)

The last organ to image will be the spleen. The goal here will be to take a still image in the sagittal view (with calipers) and a clip showing as much of the organ as possible.

SIZE OF SPLEEN

A sagittal still image with calipers can calculate the size of the spleen (as seen in the example below).

The above images are from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. The images are identical except the right image has been annotated to show the boundaries fo the spleen (outlined in red). This image is marked with calipers that can calculate the size of the spleen.

CLIP OF SPLEEN

A clip of the spleen in this orientation should be taken (like the example below).

The above clip is from a trans-abdominal ultrasound taken with the probe in the sagittal orientation. It helps show the spleen in the sagittal orientation.
SPLEEN (TRANSVERSE VIEW)

The spleen can also be imaged in the transverse view. The goal here will be to take a still image in this view and a take clip showing as much of the organ as possible.

IMAGE OF SPLEEN

A transverse still image of the spleen can be taken (as seen in the example below).

The above images are from a trans-abdominal ultrasound taken with the probe in the transverse orientation. The images are identical except the right image has been annotated to show the boundaries fo the spleen (outlined in red).

CLIP OF SPLEEN

A clip of the spleen in this orientation should be taken (like the example below).

The above clip is from a trans-abdominal ultrasound taken with the probe in the transverse orientation. It helps show the spleen in the transverse orientation.

 

Page Updated: 02.04.2018