Palpation with the probe is particularly helpful to the physician sonographer in differentiating right lower quadrant pain from pain of pelvic origin in female patients. Ultrasonography may be indicated for the evaluation of AAA, the biliary tract, acute cholecystitis, the kidneys and urinary tract, hydronephrosis, blunt or penetrating trauma, or appendicitis. Para-aortic nodes may anteriorly displace the aorta, causing the sensation of a pulsatile mass on physical examination. Aging can cause the aorta to become tortuous. The normal anteroposterior diameter of the aorta is 3 cm or less when measured from outer wall to outer wall.
Most aneurysms are fusiform or show uniform dilatation of the entire circumference of the vessel.
Aneurysms usually arise below the level of the renal arteries and are left of the midline. Their anterior expansion usually creates a good sonographic window because they push the bowel aside. The gallbladder is identified as a sonolucent, oblong, pear-shaped sac that is normally posteromedial to the right lobe of the liver. Gallstones usually lie in the most dependent part of gallbladder. Acute cholecystitis Cholelithiasis alone does not represent acute cholecystitis.