Abdomen · Uncategorized

Abdomen Ultrasound Protocol & Upper Limits of Normal Cheat Sheet

I have often wished there was a universal protocol for how we take ultrasound images that spanned across all facilities nationwide.  This would make it easier for me to compare my exam to the prior images if they are available.  It would be easier for the interpreting physician too.  If you are working amongst a group of sonographers it is likely that there is a recommendation for the order of an exam.  Many years ago I worked in a group that started at midline with the pancreas and great vessels and scanned the abdomen clockwise to the spleen, left kidney, right kidney and back around to the gallbladder and finally the liver.  The current group I’m working with starts at the liver and scans counter-clockwise to end with the pancreas and great vessels.  A universal protocol in my opinion should be this:

  1. Pancreas
  2. Inferior Vena Cava in transverse & saggital at proxmial
  3. Aorta in saggital with measurements at proximal, mid, and distal
  4. Aorta in transverse with an AP measurement distally
  5. Iliac bifurcation in transverse with measruements
  6.  Left liver in saggital
  7.  Left liver in transverse
  8.  Right liver in saggital with a measurement of liver length
  9.  MPV with color & doppler
  10.  Gallbladder in saggital with patient laying supine & include wall measurement
  11.  Gallbladder in transverse with AP wall measurement
  12.  Gallbladder saggital in LPO or LLD, be certain to include GB neck
  13.  Common bile duct & common hepatic duct with measurements
  14.  Right kidney with volume measurements (length on saggital, height & width on transverse image)
  15.   Left kidney with volume measurements
  16.   Spleen with length measurement

You might disagree with where I place my measurements for the gallbladder and the kidney volumes.  I used to measure my kidneys with length and height in the saggital dimension.  However, when I measure the height and width in my transverse image I feel that I’m getting my most accurate measurement of height in AP against the cross-section of the width.   Likewise, my gallbladder measurements might raise and eyebrow.  I realize we don’t need 2 different gallbladder wall measurements.  My personal preference is the AP wall measurement when I’m taking a transverse image of the gallbladder.  A seasoned sonographer who I hold in high regard was adamant that our wall measurements should be done with the gallbladder in a saggital view because the wall can appear falsely thick by the angle of the image in transverse.  I understand what she is saying but we are all very attentive to our images and would not measure the gallbladder wall at an odd angle to make it appear thick if it is in fact normal.

Upper Limits of Normal:

  • Liver = 15.5 cm  (Mosby’s Diagnositic Ultrasound)
  • Gallbladder = 3mm
  • CBD = 5mm without chole, 8mm with chole or equivalent to pt’s age in dilitation without obstructions.  Give attention to intrahepatic ductal dilitation
  • Kidneys = 12 cm
  • Spleen = 12 cm
  • Pancreatic Duct = 2mm
  • Aorta = 3cm for AAA criteria


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