Abdominal ultrasound is often associated with evaluating gallstones or investigating abdominal pain, but modern abdominal and retroperitoneal sonography has become far more comprehensive. Advances in ultrasound technology now allow clinicians to assess everything from liver fibrosis and renal blood flow to bowel inflammation and traumatic injuries, all without ionizing radiation. The latest guidance from the American Institute of Ultrasound in Medicine (AIUM) reflects how broadly ultrasound is being used in clinical practice today and highlights key elements of a thorough abdominal examination.

A Versatile Tool for a Wide Range of Conditions

Abdominal and retroperitoneal ultrasound is used to evaluate numerous symptoms and disease processes, including abdominal or flank pain, jaundice, hematuria, palpable masses, abnormal laboratory findings, infection, trauma, and urinary tract disorders. It also plays an important role in monitoring chronic liver disease, screening high-risk patients for hepatocellular carcinoma, evaluating transplant patients, and guiding invasive procedures.

Because of these diverse applications, today’s abdominal ultrasound examinations often extend well beyond a single organ and may include assessment of multiple interconnected systems.

A Closer Look at the Liver

The liver remains one of the most frequently evaluated abdominal organs. In addition to assessing liver size and echotexture, sonographers may evaluate the portal vein, hepatic veins, and inferior vena cava to assess blood flow patterns and identify signs of portal hypertension or vascular abnormalities.

Newer techniques are expanding ultrasound’s role in liver care. Elastography can help estimate liver stiffness and aid in the assessment of fibrosis, while contrast-enhanced ultrasound (CEUS) can improve characterization of focal liver lesions and evaluation of hepatic vasculature.

Evaluating the Gallbladder and Biliary System

Gallbladder imaging remains a cornerstone of abdominal sonography. Ultrasound is highly effective for detecting gallstones, assessing gallbladder wall thickening, and identifying findings associated with acute cholecystitis. The examination also includes evaluation of the intrahepatic and extrahepatic bile ducts for dilation, obstruction, or other abnormalities.

Patient positioning can be an important part of the exam, helping distinguish mobile calculi from polyps or impacted stones and providing a more complete assessment of the biliary system.

Seeing Beyond the Pancreas

The pancreas can be challenging to visualize because of overlying bowel gas, yet ultrasound continues to serve as an important first-line imaging tool. Whenever possible, the pancreatic head, uncinate process, body, and tail can be assessed for masses, calcifications, ductal dilation, or inflammatory changes. The surrounding tissues can also be evaluated for lymphadenopathy and fluid collections.

Ultrasound and Kidney Health

Ultrasound plays a central role in the evaluation of kidney disease. Examinations may identify hydronephrosis, renal calculi, cysts, masses, cortical thinning, or other structural abnormalities. Doppler techniques can provide additional information about renal blood flow, while CEUS is increasingly used to characterize indeterminate renal lesions without exposing patients to contrast agents used in CT imaging.

The urinary bladder is often assessed as part of a comprehensive urinary tract examination, with evaluation for wall abnormalities, residual urine volume, distal ureteral dilation, and evidence of obstruction.

Expanding Applications in Bowel Imaging

Although CT remains a common modality for gastrointestinal evaluation, ultrasound has become increasingly valuable in assessing bowel pathology. High-frequency transducers, graded compression techniques, and Doppler imaging can assist in evaluating suspected appendicitis, inflammatory bowel disease, pyloric stenosis, intussusception, and other bowel disorders.

Particularly in pediatric imaging, ultrasound offers the advantage of avoiding radiation exposure while providing real-time assessment of bowel structure and vascularity.

Ultrasound in Trauma Care

One of the most impactful emergency applications of ultrasound is the Focused Assessment with Sonography for Trauma (FAST) examination. FAST allows clinicians to rapidly evaluate for free intraperitoneal fluid in trauma patients, helping accelerate clinical decision-making in urgent situations. The examination typically includes evaluation of the right upper quadrant, left upper quadrant, paracolic gutters, and pelvis.

Technology Continues to Expand Possibilities

Several advanced ultrasound technologies are becoming increasingly integrated into routine practice, including:

• Color, spectral, and power Doppler imaging for vascular assessment.
• Contrast-enhanced ultrasound (CEUS) for lesion characterization and vascular evaluation.
• Elastography for tissue stiffness assessment, particularly in liver disease.
• High-frequency imaging for detailed evaluation of superficial structures and bowel pathology.

These advances continue to expand the diagnostic capabilities of ultrasound while maintaining its advantages of portability, accessibility, and lack of ionizing radiation.

Learn More

For readers interested in the complete recommendations, the full “AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2026 Revision” is available here:

https://onlinelibrary.wiley.com/doi/10.1002/jum.70430

The document provides detailed guidance on examination technique, organ-specific imaging requirements, documentation, quality assurance, and safety considerations for abdominal and retroperitoneal ultrasound examinations.

Cynthia Owens, BA, is the Publications Coordinator for the American Institute of Ultrasound in Medicine (AIUM).