Читать книгу Atlas of Endoscopic Ultrasonography - Группа авторов - Страница 18

Endoscopic ultrasound of the stomach differs from EUS at other sites since the stomach does not constrain the endoscope tightly. It is important to follow anatomical structures (such as in a station approach) to avoid getting lost.

The video shows models of the stomach, esophagus, duodenum, gallbladder, pancreas (brown), the aorta, splenic artery, hepatic artery and left gastric artery (red), adrenal glands (pink), and splenic, superior mesenteric veins (dark blue) as viewed from behind. A plane is passed that is similar to the image plane generated during radial array EUS. The resultant cross‐sectional anatomy starts at the level of the gastroesophageal junction, with the aorta and inferior vena cava (IVC) labeled. The aorta (which is collapsed) is followed, which brings the pancreas and left adrenal gland into view. The first artery that comes off the aorta in the abdomen is the celiac artery. There is a trifurcation into the splenic, hepatic, and left gastric arteries (LGA), although the LGA is generally smaller and difficult to see. It is shown in the video at the “x” just before the bifurcation into the celiac and hepatic arteries as identified.

Figure 1.2 Visible Human Model of esophagus, stomach, and duodenum. The red circle shows a plane parallel to the axis and is similar to a plane developed during linear array endosonography.

Figure 1.3 Transaxial cross‐section of digital anatomy taken at the level of the subcarinal space. Ao, aorta (both ascending, superior in the image, and descending, inferior in the image, are shown); Az, azygos vein; PA, pulmonary artery; RMB and LMB, right and left mainstem bronchi; SVC, superior vena cava.

The superior mesenteric artery (SMA) comes off the aorta just distal to the celiac artery. Various endoscope maneuvers can be used to bring the portal confluence into view, and then the splenic vein can be used as a guide to visualize the pancreas body, left adrenal, kidney, and spleen. The diaphragm can be easily imaged between the kidney and the vertebrae.