Abstract
This chapter describes a targeted approach to ultrasound of the liver, gallbladder, biliary system, and spleen. A standard scanning technique is initially outlined; followed by a more detailed description of the relevant sonographic anatomy for each of these organs and their normal appearance on ultrasound, with pitfalls to avoid. For each of these organs/systems, specific pathologies and their sonographic appearances have been chosen, which are thought relevant or likely to occur in patients on the intensive care unit. While some of the ultrasound findings described may directly influence the patient’s acute management, others are more incidental in their nature and should be recognised for that, to avoid unnecessary additional investigations.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Nicolaou S, Talsky A, Khashoggi K, Venu V. Ultrasound-guided interventional radiology in critical care. Crit Care Med. 2007;35(5 Suppl):S186–97.
Middleton WD, Melson GL. Diaphragmatic discontinuity associated with perihepatic ascites: a sonographic refractive artefact. Am J Roentgenol. 1988;151:709–11.
Le Couinaud C. foie: etudes anatomiques et chirurgicales. Paris: Masson; 1957.
Sidhu PS, Chong WK. Measurement in ultrasound: a practical handbook. London: Arnold; 2004.
Scatarige JC, Scott WW, Donovan PJ, Siegelman SS, Sanders RC. Fatty infiltration of the liver: ultrasonographic and computed tomographic correlation. J Ultrasound Med. 1984;3:9–14.
Jüttner HU, Ralls PW, Quinn MF, Jenney JM. Thickening of the gallbladder wall in acute hepatitis: ultrasound demonstration. Radiology. 1982;142:465–6.
Kuligowska E, Connors SK, Shapiro JH. Liver abscess: sonography in diagnosis and treatment. AJR Am J Roentgenol. 1982;138:253–7.
Hui JY, Yang MK, Cho DH, Li A, Loke TK, Chan JC, Woo PC. Pyogenic liver abscesses caused by Klebsiella pneumoniae: US appearance and aspiration findings. Radiology. 2007;242:769–76.
Vassiliades VG, Bree RL, Korobkin M. Focal and diffuse benign hepatic disease: correlative imaging. Semin Ultrasound CT MR. 1992;13:313–35.
Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W. Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med. 2008;27:657–66.
Cai YL, Xiong XZ, Lu J, Cheng Y, Yang C, Lin YX, Zhang J, Cheng NS. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: a systematic review and meta-analysis. HPB (Oxford). 2015;17:195–201.
Gandolfi L, Leo P, Solmi L, Vitelli E, Verros G, Colecchia A. Natural history of hepatic haemangiomas: clinical and ultrasound study. Gut. 1991;32:677–80.
Ebara M, Ohto M, Shinagawa T, Sugiura N, Kimura K, Matsutani S, Morita M, Saisho H, Tsuchiya Y, Okuda K. Natural history of minute hepatocellular carcinoma smaller than three centimeters complicating cirrhosis. A study in 22 patients. Gastroenterology. 1986;90:289–98.
Huang C-Y, Sun J-T, Tsai K-C, Wang H-P, Lien W-C. Hepatic portal venous gas: review of the literature and sonographic implications. J Med Ultrasound. 2014;22:66–70.
Hokama A, Arakaki S, Shibata D, Maeshiro T, Kinjo F, Fujita J. “Playboy Bunny” sign of congestive heart failure. West J Emerg Med. 2011;12:433–4.
Yoshimoto K, Ono N, Okamura T, Sata M. Recent progress in the diagnosis and therapy for veno-occlusive disease of the liver. Leuk Lymphoma. 2003;44:229–34.
Ralls PW, Johnson MB, Radin DR, Boswell WD, Lee KP, Halls JM. Budd-Chiari syndrome: detection with color Doppler sonography. AJR Am J Roentgenol. 1992;159:113–6.
Mortelé KJ, Mortelé B, Silverman SG. CT features of the accessory spleen. AJR Am J Roentgenol. 2004;183:1653–7.
Görg C1, Eichkorn M, Zugmaier G. The small spleen: sonographic patterns of functional hyposplenia or asplenia. J Clin Ultrasound. 2003; 31(3):152–5.
Llewellyn ME, Brooke Jeffrey R, DiMaio MA, Olcott EW. The sonographic “Bright Band Sign” of splenic infarction. J Ultrasound Med. 2014;33:929–38.
Sharma SK, Smith-Rohrberg D, Tahir M, Mohan A, Seith A. Radiological manifestations of splenic tuberculosis: a 23-patient case series from India. Indian J Med Res. 2007;125:669–78.
Pastakia B, Shawker TH, Thaler M, O’Leary T, Pizzo PA. Hepatosplenic candidiasis: wheels within wheels. Radiology. 1988;166:417–21.
Chou YH, Tiu CM, Chiou HJ, Hsu CC, Chiang JH, Yu C. Ultrasound-guided interventional procedures in splenic abscesses. Eur J Radiol. 1998;28:167–70.
Warshauer DM, Hall HL. Solitary splenic lesions. Semin Ultrasound CT MR. 2006;27:370–88.
WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop. 2003;85:253–61.
Goerg C, Schwerk WB, Goerg K. Sonography of focal lesions of the spleen. AJR Am J Roentgenol. 1991;156:949–53.
Goerg C, Schwerk WB, Goerg K. Splenic lesions: sonographic patterns, follow-up, differential diagnosis. Eur J Radiol. 1991;13:59–66.
Chiavaroli R, Grima P, Tundo P. Characterization of non-traumatic focal splenic lesions using contrast enhanced sonography. JCU. 2011;39; 310–315.
Gorg C, Weide R, Schwerk WB. Malignant splenic lymphoma: sonographic patterns, diagnosis and follow-up. Clin Radiol. 1997;52:535–40.
McKenney KL, Nuñez DB Jr, McKenney MG, Asher J, Zelnick K, Shipshak D. Sonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients. AJR Am J Roentgenol. 1998;170:979–85.
Perret RS, Sloop GD, Borne JA. Common bile duct measurements in an elderly population. J Ultrasound Med. 2000;19:727–30.
Romano AJ, vanSonnenberg E, Casola G, Gosink BB, Withers CE, McCutchan JA, Leopold GR. Gallbladder and bile duct abnormalities in AIDS: sonographic findings in eight patients. AJR Am J Roentgenol. 1988;150:123–7.
Raghavendra BN, Subramanyam BR, Balthazer EJ, et al. Sonography of adenomyomatosis of the gallbladder: radiologic pathologic correlation. Radiology. 1983;146:747.
Sommer FG, Taylor KJ. Differentiation of acoustic shadowing due to calculi and gas collections. Radiology. 1980;135:399–403.
Andrén-Sandberg A. Diagnosis and management of gallbladder polyps. N Am J Med Sci. 2012;4:203–11.
Ralls PW, Halls J, Lapin SA, Quinn MF, Morris UL, Boswell W. Prospective evaluation of the sonographic Murphy sign in suspected acute cholecystitis. J Clin Ultrasound. 1982;10:113–5.
Marton KI, Doubilet P. How to image the gallbladder in suspected cholecystitis. Ann Intern Med. 1988;109:722–9.
Jeffrey RB Jr, Nino-Murcia M, Ralls PW, Jain KA, Davidson HC. Color Doppler sonography of the cystic artery: comparison of normal controls and patients with acute cholecystitis. J Ultrasound Med. 1995;14:33–6.
Bloom RA, Fisher A, Pode D, Asaf Y. Shifting intramural gas—a new ultrasound sign of emphysematous cholecystitis. J Clin Ultrasound. 1984;12:40–2.
Cornwell EE III, Rodriquez A, Mirvis SE, et al. Acute acalculous cholecystitis in critically injured patients. Preoperative diagnostic imaging. Ann Surg. 1989;210:52.
McGahan JP, Lindfors KK. Acute cholecystitis: diagnostic accuracy of percutaneous aspiration of the gallbladder. Radiology. 1988;167:669–71.
Haubek A, Pedersen JH, Burcharth F, Gammelgaard J, Hancke S, Willumsen L. Dynamic sonography in the evaluation of jaundice. AJR Am J Roentgenol. 1981;136:1071–4.
Dewbury KC, Joseph AE, Hayes S, Murray C. Ultrasound in the evaluation and diagnosis of jaundice. Br J Radiol. 1979;52:276–80.
Vallon AG, Lees WR, Cotton PB. Grey-scale ultrasonography in cholestatic jaundice. Gut. 1979;20:51–4.
Laing FC, Jeffrey RB Jr, Wing VW. Biliary dilatation: defining the level and cause by real-time ultrasound. Radiology. 1986;160:39.
Muhletaler CA, Gerlock AJ Jr, Fleischer AC, James AE Jr. Diagnosis of obstructive jaundice with nondilated bile ducts. AJR Am J Roentgenol. 1980;134:1149–52.
Freeman ME, Rose JL, Forsmark CE, Vauthey J. Mirizzi syndrome: a rare cause of obstructive jaundice. Dig Dis. 1999;17:44–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Pilcher, J.M., Patel, P. (2022). Abdominal Ultrasound—Liver, Spleen and Biliary Tree. In: Walden, A., Campbell, A., Miller, A., Wise, M. (eds) Ultrasound in the Critically Ill. Springer, Cham. https://doi.org/10.1007/978-3-030-71742-1_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-71742-1_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-71740-7
Online ISBN: 978-3-030-71742-1
eBook Packages: MedicineMedicine (R0)