Anatomía (Esp)

8/2/2019 Anatomía (Esp)

http://slidepdf.com/reader/full/anatomia-esp 1/58

Anatomía para el mejor uso de

nosotros

U l t r a s o n o g r a f í a



. 2

Este es el posicionamiento popular de lacolocación de una sonda y las imágenes

(foto) en el monitor observando. Estoconcuerda con el nivel de AIUM (InstitutoAmericano de Ultrasonido en Medicina),pero no necesariamente tienen que serestrictamente igual.

Imagen Sagital Imagen transversa

El procesamiento de imágenes examinando a unpaciente desde la derecha.

El procesamiento de imágenes examinando a unpaciente desde el lado de la pierna.

vientre de lado

Parte de atrás

pie

vientre de lado

derecha

Parte de atrás

izquierda

ＡＩＵＭ（アメリカ超音波医学会）に準じた

cabeza

Imagen

Imagen Básica

Exploración sagital



. 3

Conducto biliar

Hígado

Riñón derecho

Vesícula Biliar

Riñón izquierdo

Bazo

Pancreas

Aorta

Organos Abdominales

Los órganos específicos internos de la ecografía abdominal son: el hígado, la

vesícula biliar, el páncreas, los riñones y el bazo.

Debido a que la mayoría de ellos están cubiertos con las costillas, una sonda debeser operado entre las costillas o debajo de los arcos costales.

Interior vena cava



. 4

１．Vena porta derecha２．Vena porta izquierda

３．Rama superior frontal de la vena porta４．Rama inferior frontal de la vena porta５．Rama superior posterior de la vena porta６．Rama inferior posterior de la vena porta７．Rama superior de la vena porta interior８．Rama inferior de la vena porta interior９． Rama superior de la vena porta exterior１０．Rama inferior de la vena porta exterior１１．

Ligamento redondo del hígado

Ｓ: hígado son(Clasificación de área de Couinaud)

Ｓ

Vena cava inferior

Vena hepatica central

Vena hepatica izquierdaVena hepatica derecha

Parte umbilical

Vena porta

Ｓ６

Ｓ５

Ｓ８

Ｓ７Ｓ２

Ｓ３

９

１０

８１１

２

１

６

４

５３Ｓ4

Sistema Vascular del Hígado

Es crucial comprender la posición de la vía vascular complicada por el hígado.El hígado es el más grande de los órganos sólidos en la cavidad abdominal, tocando la parte

inferior de un diafragma. El margen anterior es agudo y delgado, y el margen posterior es esferaredonda.

Vesícula biliar

Conducto biliar común

Rama izquierda de

la vena porta(parte lateral)



. 5

Couinaud Segment

Right hepatic vein

Umbilical portion

ＩＶＣ

Ｓ１

Ｓ２

Ｓ３

Ｓ５

Ｓ６

Ｓ７

Ｓ８

Middle hepatic vein

Ｓ４

Higado

Segmento de hígado: En el diagnóstico de ultrasonido, el hígado se divide en ocho segmentos, teniendo lavena porta, la vena hepática, el ligamento, la fisura, etc como indicadores. Ya que la ubicación de la lesióndescrita se indica a menudo por los ocho segmentos, que vale la pena conocer. (Segmento de Couinaud)

Vesicula biliar

Ｓ１

Ｓ２

Ｓ２

Ｓ３

Ｓ３Ｓ４

Ｓ４

Ｓ５

Ｓ５

Ｓ６

Ｓ６

Ｓ７

Ｓ７Ｓ８

IVC

Portal vein

Ｓ１： Caudado del lóbulo + Proceso de caudadoＳ２：Left lateral superior sub segmentＳ３：Left lateral inferior sub segmentＳ４：Left medial segment

Left lateral segment

Ｓ５：Right anterior inferior sub segmentＳ６：Right posterior inferior sub segmentＳ７：Right posterior superior sub segment

Ｓ８：Right anterior superior sub segment

Rightposterior

segment

Rightanteriorsegment

Right lobe

Left lobe

Liver district classification:



. 6

Exploración derecha subcostal Exploración Sagital

Cómo localizar la sonda

Rt hepaticvein

Liver ＡＯ

Liver ＳＭＡ

Higado

Middle hepatic vein

El mayor órgano del cuerpo. Se sabe que tiene una gran cantidad de funciones. Desempeña un papel crucial en elmetabolismo, excreción, desintoxicación, mantenimiento de la homeostasis de fluidos corporales, etc. Suresolución de alcohol es especialmente ampliamente bien conocida.Se segrega la bilis en el duodeno, jugando un cierto papel en la digestión, también.Su función cuenta al menos más de 500. Se dice que es imposible producir una fábrica de productos químicos conlas mismas funciones que un hígado hace cuando para expresar la amplia variedad de sus funciones. con unhígado.

Como localizar la sonda


http://slidepdf.com/reader/full/anatomia-esp 7/58. 7

１ DR × ２ Angio －３ MMG －４ RI ○ ５ CT ◎ ６ MRI ○ ７ US ○

７ US

肝血管腫

６ MRI

転移性肝癌

Exploración del corte opcional, y fácil observación de las lesiones por elexcelente contraste de tejidos.

Los metástasis de cáncer son reconocidos en todo el hígado.

５ CT

肝細胞癌肝細胞癌

En la imagen izquierda, la lesión se expresa como el área de observación dealta por los medios de contraste. En la imagen de la derecha, los huesos soneliminadas por el proceso de retoque, y la lesión se expresa como la imagen quefalta en el área de observación bajo.

４ RI

La lesión se expresa como la imagenque falta. En la gammagrafía dinámica,la ubicación es capturada cuando lafunción del hígado es la SPECT.

Higado

Carcinoma hepato celular Carcinoma hepato celular Carcinoma hepato celular

Tumor en el higado metastásico Tumor en el higado metastasico Hemangioma hepatico

Muchos de los angiomas másbrillantes que la reflexión eco delparénquima hepático sonreconocidos.



Vena porta: La vena que recoge la sangre notoriadesde el estómago, los intestinos, el páncreas, lavesícula y el bazo y la dirige hacia el hígado. Unvaso sanguíneo función del hígado.

Estómago etc. → lóbulos izquierdo y derecho delhígado → → hepatocitos venas hepáticas → vena

cava inferior

Sistema biliar: bilis (camino de los ácidos biliares,bilirrubina, colesterol, fosfolípidos, mucina,minerales Solt)

Hepatocitos → conducto hepático derecho e

izquierdo → vesícula biliar (concentración, cerca deocho veces) del conducto biliar común → →

duodeno.

左肝動脈（ＬＨＡ）

左肝管（left hepatic duct)

門脈左枝 (left portal vein）

大動脈（ＡＯ）総肝動脈（ＣＨＡ）

腹腔動脈幹（ＣＡ）

脾動脈（ＳＰＡ）

門脈本幹（ＰＶ） main portalvein

上腸間膜動脈（ＳＭＡ）

三管合流部 triple confluence

脾静脈ＳＶ（ＳＰＶ） splenic vein

上腸間膜静脈（ＳＭＶ） Vena mesentérica superior

総胆管

（ＣＢＤ）

主膵管 conducto pancreatico principal

十二指腸乳頭 papila duodenal(ファーター乳頭） papila de Vater

十二指腸 duodenum

胆嚢（ＧＢ） gall bladder

胆嚢管 Conductocístico

右肝管

right hepatic duct右肝動脈（ＲＨＡ）

門脈右枝 right portal vein

総胆管 common hepatic duct

肝 liver

La vesícula biliar y sus alrededores

La vesícula biliar está en contacto conla parte inferior del hígado, y tiene unvolumen de 30 ~ 60 ml. El conducto

biliar es una vía de bilis, y al final sepasa a través de la cabeza de páncreasdespués de pasar detrás de unduodeno, y se conecta a la papila deVater en un duodeno.La vesícula biliar se puede dividir entres segmentos de la parte cercana al

conducto cístico: la región cervical, elcuerpo y la parte basilar.



(Consejos)· Pida a un alumno para mantener la respiración profunda parasuprimir el movimiento de los órganos. Esto hace más fácilencontrar el lugar.· Para un gordo, de 45 grados la posición sentada es más fácilhacer que una imagen clara.

(Punto de control)· Lumen no tiene eco. Compruebe si hay en el interior de eco.· Compruebe si el espesor de la pared de la vesícula biliar es

aún más.

(Consejos)· A diferencia del arco inferior costal derecho, pida a un

alumno que deje de respirar.· Para un delgado, a veces se mueve dentro de la pelvis enel lado dereho del abdomen.· Se puede hacer una imagen clara de las grasas.

(Punto de control)· Compruebe si la luz no tiene eco.· Espesor de la pared de la vesícula es par, ya veces elpequeño se puede observar.

※ Tenga cuidado de no hacer un diagnóstico equivocado,teniendo como lesión.

Como localizar la sonda

GB

higado

Ramaizquierdade la venaporta

GB

liver

portal vein

Vesicula biliar

Exploración derecha subcostal Exploración derecha intercostal

How to place a probe



１ DR ◎ ２ Angio －３ MMG －４ RI ○ ５ CT ○ ６ MRI ○ ７ US ◎

７ US

Both stones and polyps are often rendered in high brightness. They

can be distinguished by changing body position and echo loss.

胆石胆嚢ポリープ

５ CT

胆石症胆石症 Contrast media enables to check if gallstones are in the gallbladder, andif there are, their sizes. 3D image tells the position, size and shape of a

gallstone.

６ MRI

胆石

The common bile duct enlargedwith gallstones is observed withoutcontrast media.

５ CT

１ DR

胆石･慢性胆嚢炎

Izquierda: Varios cálculos biliares se observan en la vesícula biliar. Derecha:Este es el caso de la inserción de un stent en el conducto biliar y la estenosistratada constreñido.

胆管癌

４ RI

健常例 Las funciones del hígado, elconducto biliar y la vesícula biliarson observados por lagammagrafía dinámica con elmomento.

Vesicula biliar

Piedra･coleocistitis Carcinoma de vesicula

Cholesterol polyp

normal

Gallstones Gallstones Gallstones

Gallstones



ＳＭＶ：ＳｕｐｅｒｉｏｒｍｅｓｅｎｔｅｒｉｃｖｅｉｎＳＭＡ：ＳｕｐｅｒｉｏｒｍｅｓｅｎｔｅｒｉｃａｒｔｅｒｙＣＢＤ：Ｃｏｍｍｏｎｂｉｌｅｄｕｃｔ

脾

spleen)

総肝動脈（ＣＨＡ）

腹腔動脈（ＣＡ）

左胃動脈（ＬＧＡ）

（ＲＧＡ）右胃動脈

脾静脈（ＳＰＶ）

脾動脈（ＳＰＡ）

膵管 pancreatic duct

左腎 left kidney

上腸間膜動脈（ＳＭＡ)

上腸間膜静脈（ＳＭＶ）

腹部大動脈 abdominal aorta （ＡＯ）

下大静脈ＩＶＣ

門脈（ＰＶ） portal vein

総胆管（ＣＢＤ）

副乳頭 accessorypapilla

十二指腸 duodenal

十二指腸乳頭 duodenal papilla

膵

pancreas

主膵管：main pancreatic duct

副膵管

accessory pancreatic duct

ＩＶＣ：ＩｎｆｅｒｉｏｒｖｅｎａｃａｖａＣＨＡ：Ｃｏｍｍｏｎｈｅｐａｔｉｃａｒｔｅｒｙ

ＲＧＡ：Ｒｉｇｈｔｇａｓｔｒｉｃａｒｔｅｒｙ

ＬＧＡ：ＬｅｆｔｇａｓｔｒｉｃａｒｔｅｒｙＣＡ：Ｃｅｌｉａｃａｒｔｅｒｙ

Ｓ（Ｐ）Ｖ：Ｓｐｌｅｎｉｃｖｅｉｎ

Pancreas, Spleen and the Surroundings

The upper side of the pancreastouches the antrum of stomachand the duodenal bulb, and thecaudal portion touches thegastric corpus. Therefore, todecrease influence fromgastrointestinal gas, 45-degreesitting position, water as muchas an examinee can drink, etcare taken to replace the gas

with liquid. However, in case ofan examinee who is fat or has acontracted pancreas, theexamination is difficult becausesometimes gastrointestinaltracts are overlapped on theabdominal side of a pancreas,thick fatty layers of omentum or

lesser omentum lie in between,

etc.



(Advice)Render the image of the hepatic left lobe and theramification point of aorta and super mesenteric artery(SMA).Render the image of the artery in membrane cavity andthe image of the pancreas body at the end.

(Checkpoint)The normal image is oval. The parenchyma is evenspotted echo.

(Advice)Turn the probe by 90 degrees in the examination on theleft picture so that the liver remains in the top of the image.Tilt the probe so that it looks down the feet and renderthe image referring to the splenic vein.When rendering the image is difficult, make an examineesit or drink water (500 ml), and give the examination asecho window*.*echo window: A window which has a good passage ofecho beams by water to eliminate the influence from gasgenerated by stomach, etc.

(Checkpoint)Surface is smooth, and magatama-shaped organ. The

paremchyma is even spotted echo.Long follow-up survey is possible for the pancreatic vein.The norm is below 2 mm in a pancreatic duct diameter.

How to place a probe.

liver

ＡＯ

pancreas pancreas

ＡＯＳＭＡ

liver

Pancreas

Sagittal Scan Pancreas longitudinal Scan

SMA





Spleen

Left Intercostal Scan

Immune Function: In the white pulp spleen, B cell (B lymphocyte), T lymphocyte and plasmocyteare matured, holding immune system against pathogens which increase in blood. When people

removed the spleen suffer from malaria, it tends to be serious.

Hematogenesis Function: During a prenatal period, a red blood corpuscle is produced in a spleenbefore a bone marrow starts hematogenesis. After delivery, this function disappears, but at massivehemorrhage or suppress of bone marrow function, it’s found that a spleen sometimes starthematogenesis (extramedullary hematopoiesis). Rats and mice continue hematogenesis in a spleenafter delivery.

Destruction of Blood Cell: The spleen destroys old blood cells. It destroy hemoglobin in red bloodcorpuscles and collect iron, on the other hand.



１ DR ◎ ２ Angio －３ MMG －４ RI △ ５ CT ◎ ６ MRI △ ７ US ○

７ US

It’s difficult to render the image of the whole pancreas by the gasinfluence. Enlargement of the

pancreatic duct becomes adiagnostic indicator.

５ CT

In the left image, low absorption region (lesion) is recognized, and thebody of the pancreas and the pancreatic duct is clearly described.

In the right image, blood vessels providing nutrition to the pancreas canbe observed three dimensionally by 3D processing.

myelolipoma/pancreatic ductnetwork

６ MRI

normalThe positions of the bile duct andthe pancreatic duct can be

observed by noninvasive waywithout contrast media.

１ DR

chronic pancreatitis

Left: The second and third ramifications are clearly described.Right: A disrupted small pancreatic duct is also clearlydescribed.

pancreatic head carcinoma

４ RI

normal

It’s performed when a malignanttumor in a pancreas is suspectedowing to a lot of gonadal exposure.

Pancreas

A pancreas cancer is suspected. enlargement of the pancreatic duct



The right adrenal gland is triangle, and located directly above the kidney. The left one is semicircular

and located in the front upper. They are small organs in adipose tissue of upper retroperitoneum.

大動脈ＡＯ下大動脈

ＩＶＣ

左副腎ｌｅｆｔ sdrenalgland

脾 spleen

左腎 left kidney

尿管

腹腔動脈ＣＡ

腎動脈 renalartery

腎静脈 renalvein

尿管 ureter

腎錐体 renal pyramid

右腎 right kidney

腎杯 renal calyx

腎盂 renalpelvis

腎皮質 renal

cortex

右副腎 right adrenal gland

上腸間

膜動脈ＳＭＡ

Kidney and the Surroundings

Kidneys are in retroperitoneum, on both sides of a spine. The left one is located in a higher position, andbigger than the right one. The port of a kidney is called portal renis. Tubular structure is arranged in theorder of a renal vein, a renal artery and an ureter from an antrum wall.




liver

Rt kidney

spleen

Lt kidney

Kidney

Rt Kidney (intercostal scan) Lt Kidney (intercostal scan)

The kidney is one of organs in a urinary system. It’s a crucial organ. Its major functionsare to filter and excrete extra water and waste from blood and maintain homeostasis ofbody fluid.

The right one touches the liver, and the image can be rendered over the liver. Fattyliver can be diagnosed by comparing echo brightness of renal parenchyma and liverparenchyma. (liver-kidney contrast)




１ DR ○ ２ Angio －３ MMG －４ RI ○ ５ CT ◎ ６ MRI ○ ７ US ○

７ US

It’s described as the lesion withfocal high brightness in the area of

low brightness in kidney cortex.

Renal angiomyolipoma

６ MRI

腎細胞癌

It gives fine contrast in softtissues and clear observation for

infiltration of lesions.

５ CT

For the kidney, contrast media is effective. Lesion (low absorption area)can be confirmed clearly by an examination with contrast media. 3Dimage makes it possible to check the location, size and form threedimensionally.

１ DR

Left: DIP examination. Checking shapes and functions of the kidney,the ureter and the urinary bladder with time being. Right: RPexamination. It’s observed that the ritght ureter of the urinary bladder flows backward and reaches the kidney.

４ RI

No findings

Dynamic scintigraphy: it canobserve forms and functions of thekidney and the urinary system.

Kidney

Renal cell carcinoma

hydronephrosis

Renal cell carcinoma



腹膜 peritoneum

直腸 rectum

精嚢 seminal vesicle

射精管 puctus deferens

肛門 anus精巣 testicle

陰嚢 scrotum

海綿体

corpus cavernosum

前立腺 prostate

恥骨 pubis

膀胱 bladder

前立腺小室 prostatic utricle

Male Reproductive Organ and the Surroundings



(Advice)Perform an examination by the full bladdertechnique.It’s suited to find a lesion in a bladder and observe

the prostate gland, but not suited to performdiagnosis of a form or parenchyma, for which aprobe specialized in a transrectal is usually usedinstead of it.(Checkpoint)Check if there’s no echo with no stones in thebladder, and the bladder wall is thin and smooth.The prostate gland is under the bladder, gives highecho and described evenly. Check if there’re no

stones or nodes.

(Advice)Render image referring to no echo area in the bladder.If image is arranged upside down, it corresponds to atransabdominal scan in a vertical relationship. It makes iteasy to understand.It sometimes renders an hazy image in bladder. (urinaryflow)(Checkpoint)The whole of the bladder or the prostate gland can be

scanned by turning a probe to the right and left.


bladder

Prostate

Transabdominal Scan Transrectal Scan

prostate




. 20

１ DR ○ ２ Angio －３ MMG －４ RI －５ CT ○ ６ MRI ○ ７ US ◎

６ MRI

Progress of the lesion can beeasily observed.

前立腺癌

５ CT

健常例

？？？？？

１ DR

前立腺肥大

７ US

Transabdominal observation of the prostate gland is possible by thefull bladder technique, but a transrectal examination gives moredetailed observation. High brightness（↓）means calcifications.

前立腺肥大前立腺石灰化

前立腺 Prostate

Prostate calcification

Normal range Prostatic carcinomaBenign prostatic hypertrophy

Benign prostatic hypertrophy

Right: CUG examination. Exclusionof the bladder and the urethra canbe well observed.



. 21

膀胱 bladder 恥骨結合 symphysis pubica

尿道 urethra

膣 vagina

肛門 anus

子宮頚部 uterine cervix

直腸 rectum

子宮 uterus

子宮腔 cavity of uterus

卵管 uterine tube

卵巣 ovaryﾀﾞｸﾞﾗｽ窩

douglas

Obstetrics and Gynecology

ObstetricsImage of size of a baby in the uterus, theposition, movement, volume of amniotic fluidand aberration in the pelvis can be rendered.US is often applied to symptoms that requireexaminations at the time of pregnancy,delivery and postpartum.

GynecologyUS is profitable to estimate an ovulation dayfor infertility, find out inflammation inhypogastrium and discriminate betweenbenign tumors and malignant ones.

In both areas, US renders clear image sincescan for body cavity through the vaginaenables contacting mucous membrance andreceive no influence from intestinal gas.Therefore it’s often used and indispensable indiagnosis of pregnancy in the early stage andplacenta previa. Recently, with a transvaginalprobe, needle aspiration of cysts and ovumcollection for artificial fertilization are studied.US is under great development as a tool of

diagnosis and treatment.



. 22

(Advice)Perform an examination by the full bladdertechnique.Render image of uterine referring no echobladder area.After rendering uterine image, observe bothovaries.Transverse scan can easily find them.

Size of the uterine differs by ages and individuals.

(Checkpoint)The uterine locates under the bladder, describedas rather high brightness. The posterior wall canbe also clearly described.Inside of the uterine has layer structure and itsoutline is well-ordered.Check if there’re no uterine swelling or abnormaltumors in the uterine.


uterus

bladder

uterus

子宮 Uterus

Transverse Scan of Uterus Longitudinal Scan of Uterus

endometrium

Transabdominal scan




. 23

(Advice)Perform an examination by the full bladdertechnique.Direct a probe a little bit to the shoulder sidecomparing to observation by cervical transversescan and render image of both ovaries.It’s recommended to refer to the old record of follicle size, how many days after the onset of theperiod, etc.

(Checkpoint)An ovarian follicle is not necessarily one. Anovarian follicle is round, described as round like

low echo area (low space).

The ovarian follicle should be scanned frommultiple directions and measure the maximumdiameter.Check if there’s no abnormality around ovaries. More detailed observation than transabdominalapproach.

Image from the cervix of uterus to the body isrendered after inserting a probe to the end.


Ovarian follicle

ovary

bladder

Ovary and Transvaginal Echo

Ovary Transvaginal Scan

endometrium



. 24

１ DR ○ ２ Angio - ３ MMG - ４ RI - ５ CT○ ６ MRI◎ ７ US◎

６ MRI

子宮頸癌健常例

It’s easy to confirm the location of the lesion because any slices areavailable (photo: SAG image). Excellent contrast in soft tissues and clearimage of structure in muscle layers of the uterine body are rendered.

１ DR

原発性不妊症

Contrast media has beenflowed in a thin uterine tube.

５ CT

子宮筋腫

With the effect of contrast media,the marginal of lesion is faintlycontrasted.

７ US

Observation of a uterine is possible with transabdominal examinationby the full bladder technique, but a transvaginal probe can render

clear fetus image（↑） .

胎児健常例

Uterus

Womb cervix cancerPrimary infertility

EmbryoNormal womb

Normal womb

Uetrus myoma



Ultrasonography of Mammaｌｙ Gland

and Thyroid Gland



. 26

皮膚 skin

Fat layer浅在筋膜浅層

乳腺 mammary gland

大胸筋 pectoralis major muscle乳腺後脂肪織 retromammary fat（乳腺後空隔 retromammary space)

クーパー靭帯

＜Mammary gland＞ Number of examination is increasing with thespread of breast cancer screening, and US exam

is indispensable. Information obtained frompalpation and technique discriminating betweenthe benign lesion and malignant one arenecessary. As examination record, it’s recommended to render image and scan in morethan two directions including a normal part.

＜Thyroid gland＞ Lymph nodes and thyroid glands are considered as atarget of US examination.

High resolution image is much employed for highfrequency around 10MHｚ.

右葉 right

左葉 left

気管 throttle

皮膚（skin）

頚動脈（carotid a.）

頸静脈（carotid v.）

甲状腺狭部

Mammary gland Thyroid gland



. 27

(Advice)Perform examination after finding abnormalityby palpation.Scan the whole breast.Remember that layer of mammary glands arenot necessarily even.

(Checkpoint)Breast parenchyma is described as slightlycoarse structure with high brightness when thereis no tumor image or abnormal reflection.

(Advice)When it is not easy to place a probe, use of a waterbag is recommended.

Simultaneous image rendering of right and leftbreasts is recommended to compare.

(Checkpoint)The thyroid gland has a butterflylike form, the leftlobe and the right one are joined in front of thetrachea.The carotid artery tomogram can be rendered at thesame time.The surface has little concaves and convexes.

Sagittal Scan Transverse Scan

Mammary Gland Thyroid Gland

trachea



. 28

１ DR × ２ Angio －３ MMG ◎ ４ RI －５ CT ○ ６ MRI ○ ７ US ◎

７ US

乳癌

Limiting is unclear, and cancers are

found with calcification inside （↑）.

６ MRI

乳癌

Both sides are observed at thesame time. Excellent contrast in soft

tissues and easy to observe lesions.

５ CT

健常例

Lay an examinee facing down. Inblood vascular system, it gives

effect of contrast media.

３ MMG

乳癌乳癌健常例健常例

In case of MMG, one image per one film. Check if there’re no abnormal parts placing images of right and left breast symmetrically. Left:These two images are right and left breasts of the same examinee scanned from the cranio-caudal direction. By comparing them,calcifications were found. Right: These two images are right and left breasts of the same examinee scanned from the side.

Mammary gland

甲状腺



. 29

１ DR △ ２ Angio －３ MMG －４ RI ○ ５ CT ○ ６ MRI ○ ７ US ◎

７ US

橋本病

Follicular adenoma: surrounded by the band of low echo with theclear borderline. In case of Hashimoto disease, the thyroid gland

is swelling as a whole.

濾胞腺腫

６ MRI

Normal Normal

Because of good contrast in tissue, it’s possible to discriminate

between soft tissue like the thyroid gland and the sounding tissue.

５ CT

Image of the enlarged thyroid gland is rendered unevenly. By 3Dreconstruction, the location of lesions, form and size are available.

１ DR

NormalThe thyroid cartilage image isrendered without blocked upshadows from halation.

４ RI

Thyroid tumorTumors are missing image owing toradioactive medication whichaccumulates in the thyroid gland.

甲状腺 Thyroid gland

Thyroid cancer is suspected. Thyroid cancer is suspected.

O th di



. 30

Osteoarthritis (変形性膝関節症)

US makes it easy to observe cartilages, which can’t be caught by X ray.

Worn out cartilages are clearly found.

Affected side Normal side

Knee cartilage

骨表面

The thickness of the cartilage can be measured！

Orthopedic

O h di



. 31

Furthermore, subluxation of the inner meniscus and thickening of

the inner sub ligament are observed.

Meniscus

Knee medial collateral ligament

X-Ry Ultrasound

Osteoarthritis （変形性膝関節症）

Orthopedics

O h di



. 32

Since image of inner structure of nerves can be rendered clearly,diagnosis of the lesion in neural parenchyma and peripheralneuropathy stenosis is possible.

The nerve can be described！

Carpal tunnel syndrome

unaffected sideaffected side

Orthopedic

Carpal – Tunnel Syndrome (手根管症候群)

O h di



. 33（Image after injecting local analgesic into synovial bursa）

GreaterTubercle

棘上筋腱

The cuff tear can be observed！！

With excellent solution ability, outline image of the torn edge of thetendon is clearly rendered.

Insufficiency Fracture Surface of the Rotator Cuff Bursitis

Orthopedics

Suprapinatus Tendon

O th di



. 34

Mechanism of fracture is imaged！！

Normal X ray describes fracture of the base of middlephalanx, but US describes more than that: avulsion fractureof the attachment of the volar plate.

Normal SideLesion Side

Volar Plate

Fracture

Orthopedics



Clinical Echocardiography

E i ti f H t



. 36

Excellent real time imaging, cardiac muscle, movement of valve and blood flow canbe observed.The heart is surrounded by ribs and lungs, the place to place a probe（①～④） has a

lot of limitation.

The main approach

① left parasternal approach② apical approach

③ subcostal approach④ suprasternal approach

Recommended body positionsfor placing probes.child ：dorsal position（ ① ～ ④ ）

adult ：left lateral position（ ① ,②）

dorsal position（ ③ ,④ ）

sitting position（ ④ ）

Ribs

lungs

Examination of Heart

Blood Flow of Heart



. 37

１．Ventricular Diastore２．Ventricular Systole

left atrium左心房

pulmonary artery肺動脈

ascending aorta上行大動脈

left pulmonary vein（from the left lung）左肺静脈（左肺から）

mitral valve (open)僧帽弁（開く）

left ventricle左心室

right ventricle右心室

Inferior vena cava (from abdomen)

下大静脈（腹部から）

tricuspid valve (open)三尖弁（開く）

right atrium 右心房

pulmonary valve (close)肺動脈弁（閉じる）

right pulmonary vein（from the right lung）右肺静脈（右肺から）

superior vena cava(from head/cervical region)上大静脈

（頭・頸部から）

ascending aorta(to the whole body)上行大動脈（全身へ）

pulmonary valve (open)肺動脈弁（開く）

left atrium 右心房

tricuspid valve (close)三尖弁（閉じる）

right ventricle右心室

pulmonary artery

(to the right & left lungs)肺動脈（左右の肺へ）

left atrium左心房

aortic valve (open)

大動脈弁（開く）

mitral valve (close)僧帽弁（閉じる）

left ventricle左心室

Inner pressure of the atrium becomes thicker than innerpressure of the ventricle, and the tricuspid valve and the mitralvalve are pushed to open, and blood that has flowed in atriumfrom the whole body and lungs comes to the ventricle. Sincepressure in the aorta and the pulmonary artery is higher thaninner pressure of the ventricle, the aortic valve and thepulmonary valve close, and pressure of the ventricle to sendout blood becomes lowest.

Inner pressure of the ventricle rises and the tricuspid valveand the mitral valve close to avoid flowing back of blood thathas flowed in the atrium. When inner pressure of the ventriclebecomes higher than pressure of aorta and the pulmonaryartery, the aortic valve and the pulmonary valve are pressed toopen, the ventricle contracts more strongly and send out bloodto the whole body and lungs with maximum pressure.

Blood Flow of Heart

?

P t l L ft V t i l L A i Vi



. 38

Lying on the left side with 45-degree slant backward in face-up position,approach from the left sternal border, the third or the fourth intercostal.

ＲＶ：right ventricleＡｏ：aortaＬＶ：left ventricleＬＡ：left atriumＡＭＬ：anterior mitral leafletＰＭＬ：posterior mitral leafket

右室

Parasternal Left Ventricular Long-Axis View

left atrium

mitral valve

aortic valve

left ventricle

Inter ventricular septum

aortaright ventricle

Parasternal Left Ventric lar Short A is Vie



. 39

●

●

● ●

● ●

Lying on the left side with 45-degree slant backward in face-up position, approachfrom the left left sternal border, the third or or the fourth intercostal.At the major axis section of the left left sternal border, turn a probe by 90 degreesclockwise.Observe from ‘a’ to ‘b’ by slanting a probe to the inside upper or outside down.

Right ventricular outf low tract

Tricuspid valve

RA

LA PV

●

RV

MV

●

Parasternal Left Ventricular Short-Axis View

AO

P t l L ft V t i l Sh t A i Vi



. 40

● ● Between a. the short axis of the aortic valve base and ｂ. the short axis of the mitral orifice, the leftventricular outflow tract is also described.● ● Left Ventricular Outflow Tract

ＲＶ：right ventricular ＲＡ：right atrium ＬＡ：left atriumＰＶ：pulmonary valve ＲＣＣ：right coronary cusp ＮＣＣ：noncoronary cusp ＬＣＣ：left coronary cusp

ＬＶＯＴ：left ventricular outflow tract


Parasternal Left Ventricular Short Axis View



. 41

● ●

・ Lying on the left side with 45-degree slant backward in face-up position, approach from theleft left sternal border, the third or or the fourth intercostal.At the major axis section of the left left sternal border, turn a probe by 90 degrees clockwise.Observe from ‘c’ to ‘d’ by slanting a probe to the inside upper or outside down.

● ●

RV

LV

IVS

Papillary muscle

LV（apex）

● ●





. 42

● ● Between ｃ. the short axis of the papillary muscle and ｄ. the short axis of apex, the left ventricularoutflow tract is also described.

ＣＴ：mitral chordae tendineae

● ●


Apical Four-Chamber View



. 43

Lying on the left side with 45-degree slant backward inface-up position, approach from the apex.

RV

TV

IVS

LV

MV

LARA

Apical Four-Chamber View

Apical Two-chamber View



. 44

LV

MV

LA

Lying on the left side with 45-degree slant backward in face-up position, approach from the apex.From probe position of four-chamber view image, turn a probe by 30 degrees clockwise: the placewhere the right ventricular chamber can’t be seen.

Apical Two chamber View

Apical Left Ventricular Long-Axis View



. 45

ＬＶ：left ventricle ＬＡ：left atriumＡｏ：aortaＲＶ：right ventricle

Lying on the left side with 45-degree slant backward in face-up position, approach fromthe apex.From the position of the first oblique tomographical image, give more 90-degree turn

clockwise.

Apical Left Ventricular Long Axis View

Cardiac



. 46

１ DR × ２ Angio ◎ ３ MMG －４ RI ◎ ５ CT ○ ６ MRI △ ７ US ◎

２ Angio

Left: left ventriculography, RAO30°, diastole phaseRight: contraction phase, scanned by 60f/s, movement of cardiacmuscle is partly bad ( ), valvular disease is found ( ).

acute myocardial infarction

４ RI

No Evidence NormalReconstruction image of SPECT (left) and SPECT data of ECGsynchronization are processed by QGS software for automatic renderingleft ventricle image. Checking cardiac function is possible with movingcine mode. (right)

７ US

Normal Normal

Various sections are available like the long axis view of left sternal LV(Left) and the apical four-chamber view. Real time diagnosis of cardiac

muscle, movement of the valve, etc.

５ CT

By imaging effectiveness, unevenmass is found in the left atrium.

mural thrombus in the left atrium

６ MRI

Scanning from multiple directions,the whole image is captured.

Normal

Cardiac



Ultrasonography of Carotid Artery

Carotid Artery



. 48

外頚動脈(ECA)External carotid artery

内頚動脈(ICA)Internal carotid artery

椎骨動脈(VA)vertebral artery

総頚動脈(CCA)common carotid artery

鎖骨下動脈腕頭動脈

Right side Area examined by US

ICA is outside of the center of a face (median sagittal plane), ECA is inside.ECA has bifurcation.

Carotid Artery

腕頭動脈（BCA)Truncus brachiocephalicus artery

鎖骨下動脈（SCA） Subclavian artery

CCA (Common Carotid Artery)



. 49

Transverse Image Rendering the transverse section of the carotid artery

running beside the thyroid gland.Chasing the range which can render image by the short axis.

Longitudinal Image Turn a probe by 90 degrees at the position

of a round slice image rendered.

CCA (Common Carotid Artery)

90°Rotaion

The right common carotid artery starts from the brachiocephalic branched at the arteryaortic arch, and the left common carotid artery starts directly from the left aortic arch.Both carotid arteries ascend the inside of the sternocleidomastoid muscle, and branchinto the internal carotid artery and the external carotid artery at the height of the superiormargin of the thyroid cartilage. The height of branch, position and angle differ fromeach individual.

ICA (Internal Carotid Artery) ECA (External Carotid Artery)



. 50

It is found that the common carotid artery is divided into the internal carotid artery and theexternal carotid artery, sliding the probe to the head side from the position where theslice of the carotid artery.

※It’s easy to see when it’s colored.

The common carotid artery is divided in two halfway when chasing it.

ICA (Internal Carotid Artery) ECA (External Carotid Artery)

CCA

ECAICA

ICA (Internal Carotid Artery)



. 51

Pay attention to the internal carotid artery, and get image of longitudinalsection with turning a probe by 90 degrees.

ICA (Internal Carotid Artery)

The internal carotid artery ascends the winding route outside of the pharynx, passes throughthe carotid canal, flows in Willis arterial circle entering the tectum of brain, and reaches the

cranium.

ICA

ECA (External Carotid Artery)



. 52

1. Slant a probe a little bit inside from the position rendering longitudinal section imageof the external carotid artery.

2. Pay attention to the external carotid artery and get image of longitudinal sectionwith turning a probe by 90 degrees.

ECA (External Carotid Artery)

ECA

Discrimination between Internal Carotid Arteryd E t l C tid A t



. 53

ECAICA

and External Carotid Artery

The internal carotid artery is outside and the external carotid artery is inside.The internal carotid artery is thicker than the external carotid artery.The internal carotid artery has much end-diastolic blood flow. (Because of low resistance)The internal carotid artery has much total blood flow.The external carotid artery has bifurcation.End-diastolic blood flow of the external carotid artery touches near the baseline. (Becauseof high resistance)In case of the external carotid artery, a wave form changes when the place around thetemple is pressed. (Influence of the superficial temporal artery)

Vertebral Artery



. 54

While rendering image of common carotid artery, move a probe fromthe body front to the back.

Usually the lower is the vertebral artery of two blood vessels intransverse process.

Loosen the steering. Lower a bit the flow speed range.

Vertebral Artery

Transverse process of vertebra

VA

Processus Transversus

Intima-Media Thickness （IMT）



. 55

By measuring the thickness of intima-media complex, check the whole arteries about arteriosclerosis.US can catch internal media complex thickness that is the combination of intimal and media in vessel

wall of the common carotid artery. → when it’s over 1.1mm, it is called ‘plaqaue’.

１cm １cm

a bc

How to Measure（Three-Point Method）

IMT Average of Three Points

Point A B Mode Distance mmPoint B B Mode Distance mmPoint C B Mode Distance mmMean Calculation: （A＋B＋C） / ３ mm

（）

1) Measurement of maximum IMT

Measure the part which is thickest in the rendered area.

(Measure the two points with the maximum thickness in thearea from the common carotid artery and carotid body ~ theinternal carotid artery.)

2) Measurement of average IMT

Measure the place with even blood vessel diameter, withoutthe carotid body, the internal carotid artery and the externalcarotid artery. At many hospitals, it’s measured by taking

successive 2 cm area containing the thickest part, dividing itinto two equal parts and calculate the average of threemeasured values.

The thickest part

IMT Measurement Point



. 56

Normality （0.6mm）

Doubt of arteriosclerosis(1.3mm)Inside of low

brightness

Outside ofhigh brightness

Outer

Media

IntimalIntima-Media Complex

(IMC)

Carotid Artery



. 57

１ DR ◎ ２ Angio ◎ ３ MMG －４ RI △ ５ CT ◎ ６ MRI ○ ７ US ○

７ US

It’s profitable to observe constrictionwhich is unclear only by black andwhite image in color Doppler.

Carotid stenosis

６ MRI

Normal

The image of blood vessels ofwide area can be rendered

depending on a coil.

５ CT

In the left image, severe constriction in the left internal jugular vein is observed withcontrast media.In the right image, the routes of blood vessels and the forms can be observed three-dimensionally.

Constriction in the left internal jugular vein

Suspicion of constriction in the leftexternal carotid artery

２ Angio

（Left）Aortography（Right）Imaging the right common carotid artery

No Evidence

１ DR

Constriction in theregion of origin of theinternal carotid arteryand the externalcarotid artery

Severe constrictionin the region oforigin of the rightinternal carotidartery

Constrictions are observed clearlyin both the images.

４ RI

Condition of the common carotidartery and subclavian artery can beobserved.

y

No Evidence No Evidence



Documents

Anatomía (Esp)