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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