What Is Involved in a Liver Ultrasound?

Maximum oblique diameter of right lobe of liver: normal value does not exceed 12-14cm. Anterior and posterior diameter of the right lobe of the liver: Normally measured 8-10cm. Transverse diameter of right lobe of liver: normal measured value does not exceed 10cm. Left liver thickness and length: no more than 6cm, no more than 9cm in length. Thickness and length below the costal margin of the right line of the clavicle of the liver: Normal human livers are not detected under the costal margin during steady breathing; when deep breathing, the length can reach 0.5-1.5 cm below the costal margin; The degree of up-and-down movement is also large. When deep breathing, the length is significantly increased, and there may even be a difference of 5-6cm compared with smooth breathing. Liver size, morphology, edge, envelope smoothing and continuity, uniformity of echo in liver parenchyma, clarity of distribution, orientation, texture of hepatic vessels and bile ducts; no abnormality in liver activity, envelope and surrounding Tissue-free adhesion. No enlarged lymph nodes in hilar and abdominal cavity; no ascites.

Ultrasound detection technology is the first choice for various liver diseases. Two-dimensional real-time ultrasound imaging is mainly used for liver morphological changes, and two-color Doppler blood flow imaging is used for liver vascular disease and hemodynamic examination. Ultrasound examination showed a liver lesion image, which is a property change of acoustic physics. The same lesions have different appearances at different stages of the course of development; while different lesions have similar acoustic and physical properties, the performance of ultrasound images may be the same. So ultrasound does not suggest a diagnosis of pathological anatomy. Ultrasound detection of a small number of liver occupying lesions cannot distinguish benign and malignant, such as diffuse liver cirrhosis and diffuse liver cancer. Some intrahepatic nodules are difficult to distinguish as inflammatory or tumor. Interventional liver biopsy or other tests can be performed under ultrasound localization if necessary.

Name

Liver ultrasound

category

liver function

Normal liver ultrasound

Maximum oblique diameter of right lobe of liver: normal value does not exceed 12-14cm. Anterior and posterior diameter of the right lobe of the liver: Normally measured 8-10cm. Transverse diameter of right lobe of liver: normal measured value does not exceed 10cm. Left liver thickness and length: no more than 6cm, no more than 9cm in length. Thickness and length below the costal margin of the right line of the clavicle of the liver: Normal human liver is not detected under the costal margin when the liver is breathing smoothly; when breathing deeply, it can reach 0.5-1.5 cm below the costal margin; for those with large vital capacity, the liver The degree of up-and-down movement is also large. When deep breathing, the length is significantly increased, and there may even be a difference of 5-6cm compared with smooth breathing. Liver size, morphology, edge, envelope smoothing and continuity, uniformity of echo in liver parenchyma, clarity of distribution, orientation, texture of hepatic vessels and bile ducts; no abnormality in liver activity, envelope and surrounding Tissue-free adhesion. No enlarged lymph nodes in hilar and abdominal cavity; no ascites.

Clinical significance of liver ultrasound

Abnormal results: (1) Cirrhosis, collateral circulation of portal hypertension was formed. (2), sub-diarrheal effusion or abscess. (3) Intrahepatic fluid lesions, such as liver cysts, polycystic liver, liver hydatid disease, and liver abscess formation. (4) fatty liver. (5) Primary or metastatic tumor of the liver. (6) Obvious vascular abnormalities in the liver, such as congested liver, abnormal portal vein lesions, and aneurysms. (7) Congenital abnormalities of the liver. (8) Schistosomiasis liver disease. (9) Hepatic trauma and bleeding. (1) Measurement of the liver The maximum oblique diameter of the right lobe of the liver: The top of the iliac crest should be displayed and observed. The audiogram of the oblique section of the subcostal hepatic margin of the right hepatic vein injected into the inferior vena cava as a standard. The maximum vertical distance, the normal value does not exceed 12-14cm. Anterior and posterior diameter of the right lobe of the liver: The vertical distance between the anterior and posterior edges of the liver measured on the intercostal section acoustic image, and the normal measurement is 8-10cm. Transverse diameter of the right lobe of the liver: The distance from the rightmost lateral edge of the liver to the right wall of the inferior vena cava, the normal measured value does not exceed 10 cm. Thickness and length of the left half of the liver: Use the sagittal longitudinal section of the abdominal aorta as the standard section to measure the thickness and length of the left half of the liver, showing the diaphragm as much as possible. The normal measurement is the thickness of the left half of the liver (including the tail shape) (Leaf) does not exceed 6 cm, and the length does not exceed 9 cm. Thickness and length below the costal margin of the right line of the clavicle of the liver: Normal human liver is not detected under the costal margin during steady breathing; when deep breathing, the length can reach 0.5-1.5 cm below the costal margin; for those with large vital capacity, The degree of liver up-and-down movement is also large. When deep breathing, the length is significantly increased. Compared with smooth breathing, there may even be a difference of 5-6cm. (2) Observe the size, morphology, margins, smoothing and continuity of the liver, as well as the apical part of the right lobe and the corners of the left outer lobe. (3) The homogeneity of echo in liver parenchyma, whether it has diffuse or focal enhancement, attenuation, increase or decrease of sound permeability. (4), the location, size, shape, number, echogenicity, presence or absence of capsules, internal liquefaction, sound halo, side-effect of loss of space, and posterior enhancement or attenuation in the liver parenchyma. (5) Hepatic vessels, bile ducts distribution, orientation, and sharpness of texture; whether there are limitations or overall thickening, expansion, distortion, narrowing, displacement, occlusion; blood flow distribution inside and outside the lesion; blood vessels With or without emboli. (6) Observe the activity of the liver during body movement and deep breathing, and whether there is adhesion between the capsule and surrounding tissues. (7) Whether there are enlarged lymph nodes in the hilar and abdominal cavity; whether there is ascites. Who needs to be checked: a healthy physical examination of the liver or a clinically-assisted diagnosis of liver disease.

Precautions for liver ultrasound

Contraindications before inspection:
Fasting (minimum 8 hours) before upper abdominal organ examination, venting and drainage if necessary; urinary filling of the bladder before pelvic organ examination; barium meal imaging and gastroscopy cannot be performed on the day of ultrasound examination to avoid gastrointestinal contents and gas Interference imaging.
Note during inspection:
When scanning the right intercostal space to observe the liver structure at the top of the right diaphragm, let the patient exhale as much as possible, and then hold the diaphragm as high as possible to hold the breath, so that the ultrasound beam can be effectively projected to the above area, so that the examiner has enough time to adjust the sound Beam projection direction and observation, analyze the characteristics of the sonogram. Similarly, in the examination of other parts of the liver, inhale as much as possible to lower the diaphragm and then hold your breath to avoid the obstruction of ribs, rib arches and gastrointestinal gas to obtain the best display.
When measuring the blood vessel blood flow spectrum, temporarily hold your breath for 3-5s, and obtain a stable spectrum within this time. Do not hold your breath for a long time to avoid causing spectrum errors.

Liver ultrasound examination process

Check posture (1), supine position: It is a routine check posture. The patient lies supine, breathing smoothly, with both hands raised behind the pillow. It is mainly used to check the left lobe, right anterior lobe and part of the right posterior lobe. (2) The patient in the left lying position is in the 450-900 lying position to the left and the right arm is raised behind the head, which is convenient for observing the right lobe of the liver, especially for the right posterior lobe. (3), semi-recumbent position, sitting position and standing position: suitable for patients with high liver position, used to understand the degree of liver activity to diagnose liver sagging. (4) Prone position: Generally not used. It is only used when the position of the liver is too high and the right lobe of the liver is significantly enlarged or needs to be differentiated from other diseases such as retroperitoneal mass. Inspection method (1), using conventional inspection real-time B-type ultrasound instrument, convex array or linear array probe, frequency 2.5-5.0MHz. Observation of hepatic blood flow requires a color Doppler ultrasound system. No special preparation is generally required before inspection. Liver cirrhosis and abdominal gas can be checked after drinking 500-800ml of water. (2) The examinee often takes a supine position, and can also take a left or right lateral or sitting position as required. Breathe calmly and evenly, but hold the breath after taking a deep breath when measuring the oblique diameter of the liver rib and the length and thickness of the left lobe. (3) Check the size and position of the liver. Routinely observe the following four sections: Start from the fifth intercostal space on the right side, measure the upper boundary of the liver, and follow the intercostal space from the right midclavicular line to the mid axillary line to the lower edge of the liver. The long axis of the liver, but you, the portal vein to the right trunk and branches of the portal vein, and the inferior vena cava. Detect the long axis of the right hepatic vein in the hepatic region from the lower right edge of the liver to the diaphragm, and measure the maximum oblique diameter of the right lobe of the liver; sagittal or oblique cuts parallel to the abdomen midline and parallel to it, showing the caudate lobe and the lower segment Vena cava; long axis of gallbladder, common bile duct. The length and thickness of the left lobe of the liver were measured in front of the abdominal aorta below the sagittal section of the xiphoid process; the probe was placed under the left costal margin, and the sound beam was directed to the left shoulder and left quarter ribs, showing the left outer lobe and left angle. The transverse or semi-transverse plane of the xiphoid process, the probe is rotated forward and backward to show the first hepatic portal, portal vein and its left trunk branch, hepatic ligament, venous ligament, three hepatic veins, second hepatic portal and part of the inferior vena cava. When liver and spleen translocations are suspected, the left intercostal space is measured and compared with the right side. The position of the gallbladder, portal vein, common bile duct and its branches in the liver, and hepatic round ligament are observed to confirm the position of the liver and spleen. (4) Display liver blood vessels. The portal vein system runs parallel to the hepatic artery, enters the liver parenchyma from the first hepatic portal, and its main branches travel within the liver; three hepatic veins return from the periphery of the liver, and enter the inferior vena cava to the second hepatic portal. (5). Detecting the direction and velocity of blood flow in the portal vein system, hepatic vein and hepatic segment, inferior vena cava, and colored blood flow at the lesion site. (6) Shows the bile duct system inside and outside the liver. Generally, the bile duct is parallel to the portal vein. It usually runs before the portal vein and has an inner diameter of about 1/3 of the portal vein. (7) For abnormal lesions in the liver, the sound beam needs to be confirmed from three directions to eliminate artifact interference. Also mark the location of the lesion in the liver, adjacent blood vessels or tissues. (8) Detection of the relationship between the liver and adjacent organs and surrounding tissues.

Liver ultrasound related diseases

Hepatic hemangiomas, congenital common bile duct cysts in children, congenital hepatic cysts in children, non-alcoholic fatty liver disease, pregnancy with cirrhosis, hepatomegaly, Bard-Geigy syndrome, liver abscess, liver injury, pediatric glycogen storage Serotype

Liver ultrasound related symptoms

Pain in the liver area, pulse sinking, liver moving, liver addiction, pulse phobia, intrahepatic calcification, hepatic vein disease, hepatic ascites, hepatic congestion, large and hard liver

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