Sectional Anatomy 1

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Sonography
Chapters 4, 6
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1

Cross Sectional Anatomy

Systematic and accurate identification and description of the human body, layer by layer

2

Computerized Tomography

CAT or CT Scan

Computed tomography, is a diagnostic medical test that produces multiple images or pictures of the inside of the body.

The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or transferred to a CD or DVD.

3

Magnetic Resonance Imaging

MRI

DO NOT GO in MRI Room

Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body.

Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the magnetic field temporarily realigns hydrogen atoms in your body. Radio waves cause these aligned atoms to produce very faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread.

4

Positron Emission Tomography

PET

A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning. A PET scan uses a radioactive drug (tracer) to show this activity.

The tracer may be injected, swallowed or inhaled, depending on which organ or tissue is being studied by the PET scan. The tracer collects in areas of your body that have higher levels of chemical activity, which often correspond to areas of disease. On a PET scan, these areas show up as bright spots.

5

Radiologic Planar Tomography

uses computer-processed x-rays to produce tomographic images (virtual 'slices') of specific areas of the scanned object, allowing the user to see what is inside it without cutting it open.

6

Anterior

toward the front

7

Posterior

toward the back

8

Medial

toward the middle

9

Lateral

toward the right and left side

10

Superficial

toward the outside

11

Deep

Deep

12

Proximal

toward the attachment point

13

Distal

away from the attachment point

14

coronal plane

divides the body into anterior and posterior

15

Sagittal plane

divides the body into right and left

16

transverse

divides the body into superior and inferior

17

What plane does pointing the notch toward patients head create in an image?

sagittal plane

18

What plane does pointing the notch toward you create in an image?

transverse

19

Notch

bump on transducer used to orientate scans

20

Screen left

patient right

21

screen right

patient left

22

When would a posterior scan be used?

Baby kidney

23
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What view?

Label the screen

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Coronal Right Lateral View

24
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What view?

Label the screen

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Coronal left Lateral View

25
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What view?

Label the screen

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Sagittal Anterior View

26
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What view?

Label the screen

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Sagittal Posterior View

27
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What view?

Label the screen

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Transverse Anterior View

28
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What view?

Label the screen

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Transverse Posterior View

29
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What view?

Label the screen

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Transverse Right-Lateral View

30
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What view?

Label the screen

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Transverse Left-Lateral View

31

Endovaginal Coronal View

Label the screen

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32

Endovaginal Sagittal View

Label the screen

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33

Endorectal Coronal View

Label the screen

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34

Neurosonography Coronal View

Label the screen

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35

Neurosonography Sagittal View

Label the screen

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36

Dorsal Cavity

Contains the cranial & vertebral cavities

37

Ventral Cavity

Subdivided include Thoracic & Peritoneal Cavities

38

Thoracic Cavity

Contains lungs, heart, and the organs of the mediastinum

39

Peritoneal Cavity

Sub-divisions include the abdominal and pelvic cavity

40

Abdominal Cavity

Contains the greater and lesser sacs

Bound superiorly by the diaphragm . anteriorly by the abdominal wall muscles, posteriorly by the vertebral column, ribs and iliac fossa, inferiorly by the pelvis.

Organs include stomach, liver, gallbladder, spleen, pancreas, small intestine, kidneys, large intestine, and adrenal glands.

41

Pelvic cavity

Subdivisions include pelvis major and pelvis minor

42

Greater Sac

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also known as the general cavity (of the abdomen), is the cavity in the abdomen that is inside the peritoneum but outside of the lesser sac.

43

Lesser Sac

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lesser sac is a diverticulum of the greater sac and is behind the stomach

The lesser sac, also known as the omental bursa, is the cavity in the abdomen that is formed by the lesser and greater omentum. Usually found in mammals, it is connected with the greater sac via the Epiploic Foramen Winslow.

44

Epiploic Foramen Winslow

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This is where the greater and lesser sac connect.

45

Peritoneum

a double-walled serous membrane that secretes serious fluid (lubricant). This is a closed sac *except in females where the Fallopian tubes open to the ovaries.

46

Parietal layer of the peritoneum

the outside layer that lines the gut (cavity)

47

Visceral layer of the peritoneum

the inside layer that lines organs

48

Mesentary

attaches small bowel

anchors the small intestines to the back of the abdominal wall. Blood vessels, nerves, and lymphatics branch through the mesentery to supply the intestine.

49

Omentum

attaches stomach to adjacent abdominal organs consists of ligimental folds of peritoneum that holds organ to organ

50

Greater Omentum

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extends from the greater curvature of the stomach and then attaches to the anterior aspect of transverse colon.

51

Mesocolon

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attaches to the large intestines

52

Intraperitoneal Structures

Liver
Gall bladder
Spleen
Stomach
Intestines
Ovaries - partially
first section of the duodenum

53

Retroperitoneal Structures

kidneys
ureters
Adrenal Glands
Pancreas
Aorta
Inferior Vena Cava
Urinary Bladder
Uterus
Prostate
Ascending Colon
Prostate
Ascending Colon
Descending Colon
Duodenum
Abdominal Lymph Nodes

54

Supracolic Compartment

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above the transverse colon

55

Subphrenic Space

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The right and left subphrenic spaces lie between the diaphragm and the liver, one on each side of the falciform ligament.

The left is closest to the stomach

56

Subhepatic Space

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right subhepatic is a potential space that exists posterior to the right lob of the liver, also called Morrison's space

left subhepatic space is a potential space that exists posterior to the left lobe of the liver.

57

Morrison Pouch

Potential space between right liver lobe and right kidney.

Fluid builds up in this space.

58

Infracolic Compartment

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in between the large intestines

59

Paracolic gutters

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troughlike spaces located lateral to the ascending and descending colon

60

Mesenteric Gutters

Right Mesenteric gutter medial to ascending colon
Left Mesenteric gutter medial to the descending colon

61

Perirenal space

contains the kidneys, renal vessels and proximal collecting systems, adrenal glands and an adequate amount of fat, surrounded by the Gerota's fascia

important because infection may collect here.

62

Pararenal Space

Subdivided into anterior and posterior

Anterior pararenal space contains the duodenum, pancreas and retroperitoneal segments of the ascending and descending colon. It also contains the roots of the small bowel mesentery and transverse mesocolon.

Posterior pararenal space contains no major organs

63

Posterior / Anterior Culdesacs

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Also called Pouch of Douglas or recto-uterine sac

There are two small pouches close to the uterus, one on either side, called the cul-de-sacs. The anterior cul-de-sac is located between the bladder and the uterus. The posterior cul-de-sac is found between the uterus and the rectum.

64

Gerota's fascia

Gerota's fascia

surrounds the Perirenal space

a thin lamina that passes around the front of the kidney and variably interleaves with the opposite anterior fascia

65

echogenicity

the ability to bounce an echo, e.g. return the signal in ultrasound examinations. In other words, Echogenicity is higher when the surface bouncing the sound echo reflects increased sound wave

66

Parenchyma

Parenchyma is the bulk of a substance

67
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Describing Organ Parachyma

Homogeneous or uniform echo texture with ranges in echogenicity.

*Liver parachyma could be described as homogeneous and moderately echogenic

68
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Describing Muscle

Dark compared to organs

Homogeneous or uniform echo texture with low echogenicity.

Muscle typically appear hypoechoic (darker) or less echogenic (bright) relative to other organ or body structure. Skeletal muscle bundles are distinctly separated by bright symmetric bands of fibroadipose sepatate that appears hyperechoic.

69
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Describing Placenta

Echo texture changes throughout a pregnancy from homogeneous of uniform with moderate to high echogenicity to heterogeneous or mixed echo pattern when interrupted by multiple vascular components

70
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Describing Tissue

Bright compared to adjacent structures

Echo texture is homogeneous or uniform and moderately echogenic. (bright)

Margins appear very bright of hyperechoic compared with adjacent structures

71
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Describing Fluid filled structures

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

72
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Describing Blood Vessels

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

73
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Describing Ducts

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

74
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Describing Umbilical cord

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

75
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Describing Amniotic sac

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

76
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Describing Brain ventricles

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

77
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Describing Ovarian folicles

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

78
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Describing Renal calyces

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

79
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Describing Urine-filled urinary bladder

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

80
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Describing Bile-filled gallbladder

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

81
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Describing Bursa

Appear Black

Lumen appears anechoic (Black; echo free)

walls appear bright; highly echogenic or hyperechic compared with adjacent structures.

82
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Describing Gastrointestinal Tract

Walls are thin and gerally appear hypoechoic or less echogenic compared with adjacent structures

The appearance of the lumen varies depending on its contents

Fluid filled appears anechoic (black)

gas or air-filled lumen will appear bright, highly echogenic, and generally hyperchoic

The lumen can also have a complex or mixed appearance.

All or individual sections of the GI tract may cast a posterior shadow where gas is present in the lumen

Enpty collapsed bowel has a distinctive "bulls eye" appearance

83
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Describing Bones

Very Bright

Appear echogenic and vary in brightness depending on the density of the structure, its distance from the sound beam, and the angle at which the beam strikes the structure

these structures either reflect or attenuate the sound beam, they appear hyperechoic or brighter compared with adjacent structures and they may cast a posterior shadow

84
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Describing fat

Very Bright

Appear echogenic and vary in brightness depending on the density of the structure, its distance from the sound beam, and the angle at which the beam strikes the structure

these structures either reflect or attenuate the sound beam, they appear hyperechoic or brighter compared with adjacent structures and they may cast a posterior shadow

85
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Describing air

Very Bright

Appear echogenic and vary in brightness depending on the density of the structure, its distance from the sound beam, and the angle at which the beam strikes the structure

these structures either reflect or attenuate the sound beam, they appear hyperechoic or brighter compared with adjacent structures and they may cast a posterior shadow

86
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Describing fissures

Very Bright

Appear echogenic and vary in brightness depending on the density of the structure, its distance from the sound beam, and the angle at which the beam strikes the structure

these structures either reflect or attenuate the sound beam, they appear hyperechoic or brighter compared with adjacent structures and they may cast a posterior shadow

87
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Describing ligaments

Very Bright

Appear echogenic and vary in brightness depending on the density of the structure, its distance from the sound beam, and the angle at which the beam strikes the structure

these structures either reflect or attenuate the sound beam, they appear hyperechoic or brighter compared with adjacent structures and they may cast a posterior shadow

88
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Describing tendons

Very Bright

Appear echogenic and vary in brightness depending on the density of the structure, its distance from the sound beam, and the angle at which the beam strikes the structure

these structures either reflect or attenuate the sound beam, they appear hyperechoic or brighter compared with adjacent structures and they may cast a posterior shadow

89
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Describing diaphragm

Very Bright

Appear echogenic and vary in brightness depending on the density of the structure, its distance from the sound beam, and the angle at which the beam strikes the structure

these structures either reflect or attenuate the sound beam, they appear hyperechoic or brighter compared with adjacent structures and they may cast a posterior shadow

90
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Right Hypochondrium

91
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Left Hypochondrium

92
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Epigastrium

93
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Right Lumbar

94
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Left Lumbar

95

...

Umbilical

96
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Hypogastrium

97
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Left Iliac

98
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Right Upper Quadrant

99
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Left Upper Quadrant

100
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Right Lower Quadrant

101
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Left Lower Quadrant

102

Midclavicular

divides each clavicle at its medium

103

Transplyoric Plane

level of the first lumbar vertebra

104

Subcostal Plane

level of the third lumbar vertebra

105

Transtubercular Plane

level of the surface of the iliac crest

106

Umbilicus

belly button

107

Xiphoid Process

is a small cartilaginous process (extension) of the lower part of the sternum

108

Inferior costal Margins

the lower edge of the chest (thorax) formed by the bottom edge of the rib cage

109

Iliac Crest

The iliac crest is the curved superior border of the ilium

110

Midline of the body

the imaginary line that divides the body into equal right and left halves

111

Symphysis Pubis

is a midline or secondary cartilaginous joint located between the left and right pubic bones of the median plane

112

lateral angle of the ribs

the bone forming the lateral thoracic wall,

113

medial angle of the ribs

...

114

Sternum

commonly known as the breastbone

115

Sternal Notch

well-defined, triangular depression in the lower front of the human throat. It rests between the collarbones and is defined by the large sternocleidomastoid muscles on either side of the front-facing surface of the neck.

116

Midaxillary line

divides the body into equal anterior and posterior parts

117

homogeneous

regular pattern

describes uniform or similar echo patterns of organ parenchyma on a sonographic image

118

anechoic

black

echo-free

119

isosonic

equal

same echogenicity

120

hetererogeneous

irregular pattern

describes irregular or mixed echo patterns of organ parenchyma on a sonographic image

121

hyperechoic

brighter

Increased echogenicity or an area where the echo are brighter relative to surrounding structures

122

hypoechoic

darker

Decreased echogenicity or an area where the echo are darker relative to surrounding structures

123

Diffuse Disease

infiltrative disease throughout an organ that disrupts the otherwise normal sonographic appearance of an organ parenchyma

124

Describing the sonographic appearance of localized disease

1. origin - intraorgan or extraorgan
2. size
3. composition
4. number
5. any associated comp. with adjacent organs

125

Localized Disease

represents a circumscribed mass or multiple masses

126

intraorgan

originates within the organ

features
disruption of the normal internal architecture
external bulging of organ capsule
displacement of adjacent body structures

127

extraorgan

originates outside the organ

features
displacement of other organs or structures
obstruction of other organs or structures from view
internal invagination of organ capsules
discontinuity of organ capsule

128

Solid Masses

made of tissue

neoplasms - abnormal growth of existing tissue, either benign or malignant

129

The level of echogenicity depends on?

*What type of tissue
*the degree of density
*effects on internal architecture

130

True cyst or simple cyst

*must appear anechoic with no internal echoes
*walls must be well defined, thin, and smooth
*exhibit posterior through transmission

131

When cyst criteria may be difficult to meet

* far in the body beyond the focal point of the transducer. not enough sound waves are being generated to pass through the fluid to create enhancement effects

* located directly anterior to a bony structure, which absorbs the waves, preventing through transmission

132

Ascites

accumulation of serous fluid anywhere in the abdominopelvic cavity

133

Pleural effusion

collection of fluid around the outside of the lungs

134

septation

thin, membranous inclusions found in some cystic masses

135

Complex Mass

containing both fluid and tissue components

maybe primarily cystic or primarily solid

wall vary from well-defined and smooth to porrly-defined and irregular