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02 US Tecnica de Ultrasonido Hepatico
02 US Tecnica de Ultrasonido Hepatico
Liver
INTRODUCTION
Though occasionally evaluated solitarily, the liver is often included with the
sonographic analysis of the entire right upper quadrant or abdomen. When the
liver is indeed solitarily examined, it is most often done so following other
imaging studies, such as computed tomography scan as a follow-up procedure.
Consequently, it is important most often to examine the surrounding structures
in concert with the liver, including the abdominal aorta, inferior vena cava
(IVC), gallbladder, biliary ducts, right kidney, and pancreas.
PATIENT PREPARATION
Patient preparation is focused on eliminating bowel gas and having the
potential of a fully distended gallbladder at the time of the examination.
NPO for 6–8 hrs is optimal, though fewer hours may be required, especially for
pediatric cases or those requiring emergency sonographic investigation.
If the examination is performed without fasting, proper documentation should
take place.
SUGGESTED EQUIPMENT1
3–5-MHz transducer (higher frequencies can be used for thin patients)
A high-frequency linear transducer to evaluate the contour of the liver for signs
of nodular irregularity, especially in patients who have abnormal liver function
General abdominal setting (most machines)
Harmonics or supplementary artifact removal technology to eliminate false
echoes
Positional sponges for decubitus images
CLINICAL INVESTIGATION
Laboratory values are listed in Table 3-1.2
Evaluate prior imaging reports and images including CT, MRI, radiography,
and any other appropriate tests.
Figure 3-9. Transverse hepatic veins. A transverse section through the liver
at the level of the hepatic veins. ASRL, anterior segment of the right lobe;
ARHV, accessory right hepatic vein; LSLL, lateral segment left lobe; LHV,
left hepatic vein; MHV, middle hepatic vein; MSLL, medial segment left lobe;
PSRL, posterior segment of the right lobe; RHV, right hepatic vein.
(Reprinted with permission from Kawamura D, Nolan T, eds. Abdomen and
Superficial Structures. 4th ed. Philadelphia, PA: Wolters Kluwer; 2017.)
Provide an image of the porta hepatis and branches of the portal veins if
possible (Fig. 3-11).
Provide several images of the right lobe of the liver while scanning through
the patient’s provided sonographic windows by angling the transducer
throughout the windows.
Additional images:
Some institutions’ sonographic protocols, such as a complete abdominal
sonogram or right upper quadrant, include required images of the pancreas,
gallbladder, bile ducts, and right kidney. Please see the associated chapters in
this text for further guidance.
Doppler assessment of the hepatic vasculature:
Provide images that include Doppler interrogation of the main portal vein,
hepatic artery, and hepatic veins to demonstrate normal flow patterns (Fig.
3-12).
Figure 3-10. Transverse portal veins. A: Transverse image of the left portal
vein (LPV) demonstrating its medial and lateral branches. B: Transverse
image of the right portal vein (RT PORTAL) and its posterior and anterior
branches. (Part A reprinted with permission from Kawamura D, Nolan T, eds.
Abdomen and Superficial Structures. 4th ed. Philadelphia, PA: Wolters Kluwer;
2017.)
Figure 3-11. An oblique plane through the right upper quadrant visualizes
the portal vein (PV) as it enters the liver and branches into the right portal
vein (RPV) and the left portal vein (LPV). (Courtesy of Philips Medical
System, Bothell, WA.)