Normal Variant in

Abdominal Ultrasound
Definition
• A normal variant is an atypical finding that is seen in a percentage of
the population, which generally has no clinical significance, and is
considered within the spectrum of normal findings.
Sonographic appearance
Gall bladder
a normal gall bladder should appear thin walle at least <3mm and
anechoic. It is a pear shaped saccular structure for bile storage in the
right upper quadrant. Its size will varies depends on the amount of bile
contained. If patient fasted for at least 4 hour it will be approximately
10 cm long. ( Abdellah Nazeer, 2017)
Normal variant
• Gall bladder
1. Shape variations :
a) Segmental contractions : these segments disappear when the patient changes
position or fasts.
b) Phrygian cap : the fundus is folded over giving the gallbladder a ‘capped’
appearances
2. Position variations :
c) The position and location of the gallbladder is variable because it is
suspended by long mesentery.
d) Very rare, deep fossa, intrahepatic gallbladder.
3. Septations :
a) May partially or totally divide the gallbladder
Cont.
• Biliary tract
1. Duplications :
a) Although very rare, the common duct may be partially or
completely duplicated.
2. Level variations :
b) The level of the junction of the cystic and common hepatic ducts is
variable.
3. Septations :
c) May partially or totally divide the cystic duct, producing various
degrees of double gallbladder.
Ultrasound image
• Gall bladder
Sonographic appearance
Kidney
9-12 cm long, 4-5 cm wide, 3-4 cm thick ,Gerota’s fascia encloses kidney,
capsule, perinephric fat
•Sinus
–Hilum: vessels, nerves, lymphatics, ureter
–Pelvis: major and minor calyces
•Parenchyma surrounds the sinus
–Cortex: site of urine formation, contains nephrons
–Medulla: contains pyramids that pass urine to minor calyces. Columns of
Bertin separate pyramids
Normal variants
1. Dromedary humps :
a) Cortical bulges on the lateral border of the kidney that appear the same as normal renal cortex.
2. Hypertrophied column of bertin :
b) Enlarged columns of renal cortex that vary in size and indent the renal sinus.
c) They appear the same as normal renal cortex.
3. Double collecting system :
d) The renal sinus is divided by a hypertrophied column of bertin.
e) The appearance is the same as normal renal cortex and two normal renal sinuses.
4. Horshoe kidney :
f) The kidneys are connected, usually at the lower poles.
g) Except for their connection, the kidneys appear otherwise normal.
5. Renal ectopia :
h) One or both kidneys may be found outside the normal renal fossa.
i) Other locations include the lower portion of the abdominal or pelvic cavities and in rare cases they
may be found in the intrathoracic area. Except for the location, the kidneys appears otherwise
normal.
• Extra Renal Pelvis refers to the presence of the renal pelvis outside
the confines of the renal hilum. It is a normal variant that is found in
~10% of the population .
•The renal pelvis is formed by all the major calyces. An exta-renal pelvis
usually appears dilated giving a false indication of an obstructive
pathology.
Ultrasound image
Sonographic appearance
Liver
• The liver is an irregular, wedge-shaped organ that lies below the
diaphragm in the right upper quadrant of the abdominal cavity and is
in close approximation with the diaphragm, stomach and the
gallbladder. It is largely covered by the costal cartilages.

• The liver usually measures : 

craniocaudal length: 10-12.5 cm
transverse diameter: 20-23 cm
Normal variant
• Reidels Lobe :
Inferior extension of the right lobe.

• Absence of left lobe :

Very rare. Results from occlusion of the left hepatic vein due to
abnormal extension of neonatal spasm of the ligamentum venosum.

• Multiple size and shape variations.

Ultrasound image
Sonographic appearance
Pancreas

The pancreas may have the shape of a dumbbell, tadpole or sausage. It can be divided into four main
parts:
• head: thickest part; lies to the right of the superior mesenteric vessels (
superior mesenteric artery (SMA), superior mesenteric vein (SMV)
• uncinate process: extension of the head, posterior to SMV
• attached to "C" loop of duodenum (D2 and D3)
• neck: thinnest part; lies anterior to SMA, SMV
• SMV joins splenic vein behind pancreatic neck to form portal vein
• body: main part; lies to left of SMA, SMV
• anterior surface is covered with peritoneum forming the posterior surface of the omental bursa (lesser sac)
• splenic vein lies in groove on posterior surface of body
• tail: lies between layers of the splenorenal ligament in the splenic hilum
Normal variants
• The size, shape and lie of the pancreas are normally variable.
• The duct of Santorini is a normal variant accessory duct.
Ultrasound image
Sonographic appearance
Spleen
• The spleen has a homogeneous, "inverted comma" appearance.
When it becomes enlarged it loses this shape and, as it expands, it becomes very
rounded and sometimes appears as an egg shape extending beyond the Left kidney.

Measurement:
• Normal Spleen Size
• <13 cm superior to inferior axis 
• 6-7cm in the medial  to lateral axis
• 5 to 6cm in the anterior to posterior plane. Average volume is approximately 350mls
• Ref : SONOGRAPHY Introduction to Normal Structure and Function Second Edition  Reva
Arnez Curry and Betty Bates Tempkin   Saunders
Normal variants
• Accessory spleen :
a) Splenic tissue found separate from the organ ; most often at the
splenic hilum.
b) Sonographic appearance is the same as normal splenic tissue.

• Asplenia :
a) Rare absence of the spleen often associated with congestive heart
disease.
Ultrasound image
The end