O 542mm

Fig. 49.1a

The material about the spleen presented in the preceding tained in the text, and the answer to question 5 is found on three pages should have prepared you to answer the follow- page 77. ing questions. The answers to questions 1 to 4 are con-

11 What are the diameters (maximal values) of a normal spleen?

9 What structure frequently superimposes air over the spleen and how can this be remedied?

El What must the examiner search for in patients who have sustained a blunt abdominal trauma?

Q I low should the examination be extended .if a splenomegaly is found?

9 Examine this image of a clinical case step by step:

— What sonographic section is it?

— What organ is primarily shown?

— What other structures can be seen?

— Is the parenchymal pattern normal?

— If the answer is negative, how can the changes be described?

— Try to give a differential diagnosis.

Fig. 50.1

Notes

The endosonographic presentation of the mural layers of the Gl tract:

Gastric lumen (26)

Strongly echogenic mucosal interface (a) Weakly echogenic mucosa (b) Strongly echogenic submucosa (c) Weakly echogenic lamina muscularis (d) Strongly echogenic serosa interface (e)

The endosonographic presentation of the mural layers of the Gl tract:

Gastric lumen (26)

Strongly echogenic mucosal interface (a) Weakly echogenic mucosa (b) Strongly echogenic submucosa (c) Weakly echogenic lamina muscularis (d) Strongly echogenic serosa interface (e)

The normal mural layers of the Gl tract can be seen in Figure 51.1. Abdominal sonography at best shows three (c, d, e) of the five mural layers. The transducer is placed over the left upper quadrant of the abdomen (Fig. 51.2a). In the NPO patient, the mural layers (74) of the gastric antrum (26) can be seen behind the liver (9) and directly in front of the pancreas (33) (Figs. 51.2b, c). Air shadowing (45) precludes a reliable evaluation in patients who have meteorism or are postprandial. If the stomach is markedly distended (Fig. 51.3), wall-based tumors (54) or muscular thickening as manifestation of pyloric hypertrophy (Figs. 51.4, 51.5) must be looked for.

Depending on its state of contraction, the gastric wall should measure 5-7 mm and the hypoechoic lamina muscularis by itself not more than 5 mm. Any suspicious gastric lesions should be further evaluated by gastroscopv or radiography.

Fig. 51.2a

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