Ultrasound Measurements

	B	C	D	E	F	G	H	K	L
1	Exam/Assessment	Measurements	Parameters/Instructions	Notes/Other				References & Other Notes
2		GREEN = NORMAL / RED = ABNORMAL						https://radiopaedia.org/articles/normal-radiological-reference-values?lang=us
3
4	Aorta						https://www.cardioserv.net/master-aortic-measurements-5-techniques/
5	Aortic Root	Aortic Root = Aortic Annulus → Sinus of Valsalva → Sinotubular Junction
6	Aortic Annulus	1.8 - 2.3 cm (some say 2 - 3.1 cm)	PSLA - Zoomed-In View of the LVOT - Mid-Systole (aka when aortic valve is open) - Inner-to-Inner	- Can use "Zoom Mode" to more accuratly measure
7	Aortic Root Diameter	≤ 3.9 cm	PSLA - Outer-to-Inner ("Leading Edge to Leading Edge") - End-Diastole (aka when aortic valve is close) - Measure the Widest Part of the Proximal Ascending Aorta	- Sinus of Valsalva = Widest Part (normal is <4.5 cm) - Size can vary based on gender, BMI & other factors, but should not be larger than 4.5 cm				https://www.tamingthesru.com/blog/ultrasound/ultrasound-of-the-month/april-2022
8	Abdominal Aorta	< 3 cm	Outer-to-Outer Diameter Normal
9		>3 >5 cm + Hypotension	Abnormal = Ruptured AAA if no other cause of the hTN is found
10
11	Common Iliac Artery	≤ 1.5 cm	Normal
12		(>1.5) x (Normal Diameter)	> 2.5 cm = Common Iliac Artery Aneurysm (IAA)
13			Ectatic if ≥ 1.5 cm = Female / ≥ 1.7 cm = Male
14
15
16	Appendix	Wall Thickness & Diameter = Measured from Serosa to Lumen
17	Wall Thickness	< 3 mm	Normal	Features of a Normal Appendix:		Wall Thickness <3 mm / Diameter < 6 mm
18		> 3 mm	Abnormal	- Compressible, Blind-Ended Tubular Structure
19	Diameter	< 6 mm	Normal	- Surrounded by Normal Appearing Fat
20		> 6 mm	Abnormal					Secondary Signs	***
21		> 6 mm + Non-Compressible → suspicious for Appendicitis		Features of Appendicitis: Wall Thickness >3 mm / Diameter >6 mm
22				- Hypervascular Wall with Color Doppler
23				- Free Fluid and Presence of Appendicolith are Secondary Signs ↳ Appendicolith = Hyperechoic with Posterior Shadowing
24
25	Bladder					https://go.rubbercitysono.com/SonoSnack-Bladder-Volume		https://www.pocus101.com/bladder-ultrasound-made-easy-step-by-step-guide/
26	Post Void Residual Volume	L x W x H x (.75 )					Correction Coefficient Chart
27		< 100-150 mL	Normal				***
28		> 200 mL	Urinary Retention
29
30	Bladder Wall Thickness	< 5 mm	Normal Empty Bladder	<10% Expected Volume		Norma Adult Bladder Volume = 300-400 mL		https://radiopaedia.org/articles/urinary-bladder-wall-thickening-1?lang=us
31		< 3 mm	Normal Distended Bladder	>25% Expected Volume
32
33
34	Bowel
35
36	Small Bowel Luminal Diameter	≤ 2.5 cm > 2.5 cm	Normal Abnormal = Dilated
37	Small Bowel Wall Thickness	≤ 3 mm > 3 mm	Normal Abnormal
38
39	Small Bowel Obstruction	≥ Loops Dialted (>2.5 cm)	Non-Compressible Small Bowel Proximal to Collapsed-Compressible Bowel					https://radiopaedia.org/articles/small-bowel-obstruction?lang=us
40	↳ SBO Secondary Signs → Localized Bowel Wall Edema (>3mm thick), Free Fluid Between Bowel Loops (Tanga Sign), Abnormal Peristalsis/"To and Fro Peristalsis"
41
42	Large Bowel Diameter	5 cm***						Ma & Mateer's*
43	Cecum	<9 cm	A cecal diameter of 12 to 15 cm increases the risk for cecal rupture (7)					https://radiopaedia.org/articles/large-bowel-obstruction?lang=us
44
45	Diverticulitis
46	Bowel Wall Thickeness	> 4-5 mm
47
48
49	Cardiac
50	Cardiac Measurements Sheet
51
52	DVT
53	Anatomic Areas for Compression	1. CFV above SJF → 2. SFV → 3. Proximal FV just below SFJ → 4. Mid FV → 5. Distal FV (if possible) → 6. Popliteal Vein → 7. Popliteal Trifurcation
54
55
56	Epiglottis
57	Thickness (Anterior-Posterior Diameter)	< 3 mm	Normal	Measure A-P Diameter in the Center of the Epiglottis
58				(Small Study showed Lateral Edges <3.2 mm is normal, and pt's with Epiglottitis to have Lateral Edges >3.6 mm)
59
60	FAST
61	Morrison's Pouch	0.5 cm stripe	~ 500 cc fluid
62		1.0 cm stripe	~ 1000 cc fluid
63
64	Gallbladder
65	Common Bile Duct Diameter	< 6 mm > 7 mm	Normal < 10 mm in pts WITHOUT a Gallbladder Abnormal = should be considered Dilated	Normal CBD expected to ↑ 1 mm every decade over 60 Rule of Thumb = CBD should be < 1st # of pts age - CBD can be 8-9 mm if Elderly or Post-Cholecystectomy				https://www.acep.org/sonoguide/basic/gallbladder/ https://ultrasoundpaedia.com/gallbladder-normal/ https://www.emra.org/emresident/article/common-bile-duct https://radiopaedia.org/articles/gallbladder?lang=us
66	Anterior Wall Thickness	≤ 3 mm > 3-4 mm	Normal Abnormal	GB Wall Thickening DDx: - Cholecystitis, Adenomyomatosis, Cancer, AIDS Cholangiopathy, Hepatitis, Pancreatitis, CHF, Hypoproteinemia
67	Width	3-4 cm (<5 cm)	Short Axis (Transverse Diameter)*	*Outer Wall to Outer Wall
68	Length	7-10 cm (<10 cm)	Long Axis (Sagittal Diameter)
69
70	IVC	Measure 2 cm below CavoAtrial Junction
71	Central Venous Pressure (CVP)	CVP 0-5 mmHg	≤ 2.1 cm with > 50% Collapse	3	IVC Collapses:
72		CVP 5-10 mmHg	≤ 2.1 cm with < 50% Collapse > 2.1 cm with > 50% Collapse	8	- during Inspiration in Spontaneous Breathing pts - during Expiration in Mechanically Ventilated pts
73		CVP 10-20 mmHG	>2.1 cm with <50% Collapse	15
74
75	Liver
76	Superior-Inferior Dimension (Craniocaudal Length)	< 15 cm > 15.5 cm	Normal Hepatomegaly
77
78
79	Lung
80	Pleural Effusion	Pleural Effusion Volume ( in mL)						https://radiopaedia.org/articles/pleural-effusion-volume-ultrasound?lang=us
81	Balik Formula	Distance (in mm) x 20	- Patient → Supie, with Mild Trunk Elevated at ~15° - Probe → Posterior Axillary Line - Transducer → Perpendicular to DorsoLateral Chest Wall (Transverse Plane) - Measure at End-Expiration Measure → Maximal Distance (in mm), between the Visceral & Parietal Pleura (craniocaudal measurement)
82	Eibenberger Formula *due to subtration in this equation, calculation can cause an spurious negative value if the distance between pleural layers is small (<18 mm) ↳ for very thin effusion = use Balik Formula	( 47.6 x Distance ) - 837	- Patient → Supine - Probe → Posterior Axillary Line - Transducer → Perpendicular to Chest Wall - Measure at Maximum Inspiration Measure → Maximal Distance (in mm), between the Lung & Posterior Chest Wall
83	Goecke Formula		- Patient → Supine
84	Goecke 1
85	Goecke 2
86
87
88	MSK
89	AC Joint	***
90
91	Tendinopathy:
92	Achilles Tendon	< 6 mm	Measured at level of Medial Malleolus
93	Patellar Tendon	3-4 mm
94	Plantar Fascia	≤ 4 mm	Normal					https://radiopaedia.org/articles/plantar-fasciitis?lang=us
95		> 4 mm	Plantar Fasicitis
96
97	Ocular
98	Optic Nerve Sheath Diameter (ONSD)	Measured 3 mm from Posterior Globe Margin - Minimize Gain (↓ echoes that can make the borders of the ONS hard to see/define)		- ONSD most often taken at a distance of 3 mm from the posterior globe margin as this is believed to be the site of maximum pressure changes along the long axis of the optic nerve
99	"3x5 Card"	≤ 5 mm	Normal - Normal ICP = 5-15		- Some studies have shown UNL to be 5.7 mm (ethnicity suggested to play a role) - Literature supports ONSD >5.8 mm to correlate need for intervention - However, amount of ONSD dilation has not been found to be proportional to the Δ in ICP
100		> 5 mm (bilaterally) (some studies say >6)	Corresponds with Elevations in ICP > 20mmHg - ONSD >5 mm = 99% Sn, 75% Sp for ↑ ICP - As OSND ↑s = Specificity ↑s for ↑ ICP - Measurements typically plateau ~7.5 mm even w/ extremely high ICPs		Normal ONSD by Age: > 15 yo → ≤ 5-6 1 - 15 yo → < 4.5 < 1 yo → < 4			https://pubmed.ncbi.nlm.nih.gov/24002686/