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A full-wave model for nonlinear ultrasound propagation through a heterogeneous and absorbing medium in an axisymmetric coordinate system is developed. The model equations are solved using a nonstandard or k-space pseudospectral time domain method. Spatial gradients in the axial direction are calculated using the Fourier collocation spectral method, and spatial gradients in the radial direction are calculated using discrete trigonometric transforms. Time integration is performed using a k-space corrected finite difference scheme. This s