Cardiovascular Sonographers, Inc
LIMITED ABDOMEN/RUQ WORKSHEET
Comments:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Name:____________________________________________ Date:_____/_____/____ ID:_________________
DOB: _____/______/______ Age:______ Sex: M / F Referring Physician:_________________________
Indications:__________________________________________________________________ Tech:_________
Height: _____________ Weight:______________
Pancreas: ( Abnormal Echogenicity/Echotexture ( Inflammation/Increased Size ( Cyst ( Mass
Liver: ( Abnormal Echogenicity/Echotexture ( Inflammation/Increased Size ( Cyst ( Mass
Length: ___________cm Portal Vein Flow: Hepatopedal / Hepatofugal
Gallbladder: ( Stone (Mobile) ( Stone (NON mobile) ( Internal Echoes /Sludge ( Mass ( Wall Thickening ( Fluid Collection ( + Murphy’s Sign ( Polyp
Wall:_____cm
Biliary Tree: ( Echogenic Foci ( Dilated ( Internal Echoes
CBD: ____________mm
Right Kidney: ( Abnormal Echogenicity ( Decreased Size ( Cyst ( Mass ( Echogenic Foci
_______ X _______ X _______cm R/I:______
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