AL-SHIFA CLINIC & MATERNITY HOME

PATIENT NAME:______________________________________________ AGE:_________________________

DATE:______________________________________________________ SEX :_________________________
LIVER:
 Size Normal
Enlarged Minimal – Moderate – Massive
Shruken Minimal – Moderate
 Surface : Smooth – Irregular
Suggestion of _____________________________________________________
 Parenchymal Echogenecity: Normal – Increased – Decreased - Heterogonous
Suggestive of ______________________________________________________
 Focal Mass: No
Yes (Size) _________________________ Site ____________________________
Outer Surface – Smooth or Irregular
Conustency: Cytic – Solid – Complex
Above Mentioned Focal Mass resembles with
 Hepatic Veins: Normal – Dilated – Obliterated
 Portal Veins: Normal – Dilated – Obliterated
 Intra Hepatic Ducts: Normal – Dilated
 Free Fluid Around Liver: Absent
Present: Minimal – Moderate – Massive
- Ascites ___________________________________________________
- Pleural Effusion ____________________________________________
- Sub Diaphragmatic Collection _________________________________
GALL BLADDER:
 Size Normal – Enlarge - Contracted
 Stone: No
Yes (Number) ________________________ Size _________________________
 Sludge: No
Yes
 Growth: No
Yes (Size) ________________________________________________________
 Wall: Normal – Thickened
a) Increased Echogenecity
b) Decreased Echogenecity
 CBD: Measure _________________________ cm
PANCREAS:
 Size: Normal – Enlarge
 Focal Mass: No
Yes (Size) _____________________ Consistency _________________________
 Echogenecity: Normal – Increase - Decreased
Yes – Suggestion of __________________________________________________
 Calcificaton: No / Yes
Yes – Regular – Irregular
 Duct: Normal / Dilated
SPLEEN:
 Size: ____________________________________ cms
 Focal Mass: No
Yes (Size) _____________________ Consistency _________________________
 Echopattern: Normal - Increase - Decreased
 Spleen Vein: Normal - Dilated
 Fluid Around Spleen: No / Yes
Comments:

Dr. ________________________
(Sonologist)