Small Animal Diagnostic Ultrasound

Inside front cover
Front matter
Small animal diagnostic ultrasound
Copyright
Dedication
Contributors
Editors
Contributors
Preface
Acknowledgments
Contents
Video contents
Instructional “how-to” videos
Abdominal ultrasound scanning techniques
Ultrasounds of the eye
Ultrasounds of the neck
Ultrasounds of the thorax
Ultrasounds of the heart
Ultrasounds of the liver
Ultrasounds of the spleen
Ultrasounds of the pancreas
Ultrasounds of the gastrointestinal tract
Ultrasounds of the peritoneal cavity
Ultrasounds of the adrenal glands
Ultrasounds of the urinary tract
Ultrasounds of the prostate and testes
Ultrasounds of the ovaries and uterus
1 Fundamentals of diagnostic ultrasound
Basic acoustic principles
Wavelength and frequency
Propagation of sound
Reflection and acoustic impedance
Scattering and speckle
Refraction
Attenuation
Instrumentation
Pulser
Transducer
Receiver
Scanner controls
Power (intensity, output) control
Overall gain (amplification) control
Time-gain (depth-gain) compensation controls
Dynamic range (contrast or log compression)
Gray-scale maps
Colorized gray-scale maps
Modes of image display
Amplitude mode
Brightness mode
Motion mode
Real-time B-mode
Types of transducers
Array scanners
Linear array
Curvilinear array
Phased array
Transducer selection
Image quality
Spatial resolution
Summary for image quality
Special new imaging modes
Tissue harmonic imaging
Spatial compounding
Extended field of view
Three-dimensional ultrasound
Image orientation and labeling
Image interpretation and terminology
Imaging pitfalls and artifacts
Propagation artifacts
Secondary lobe artifact
Slice thickness artifact
Reverberation, ring-down, and comet-tail artifacts
Mirror image artifact (multipath)
Refraction
Propagation speed error
Attenuation
Shadowing
Edge shadowing
Enhancement
Doppler ultrasonography
Principles of Doppler
Pulsed-wave Doppler ultrasonography
Continuous wave Doppler ultrasonography
Interpretation of the Doppler spectral display
Color Doppler
Power Doppler
Instrumentation
Doppler controls
Gain
Pulse repetition frequency (velocity scale)
Doppler transducer frequency
Baseline control
Persistence
Color write priority
Wall filters
Important Doppler Artifacts
Aliasing and range ambiguity artifact
Twinkling artifact
Safety of diagnostic ultrasound
References
2 Ultrasound-guided aspiration and biopsy procedures
Equipment
Preparation of the patient
General techniques
Indirect guidance
Freehand guidance
Needle guidance systems
Principles of needle selection and biopsy
Needle selection
Aspiration and biopsy technique
Potential complications
Slide preparation techniques for fine-needle aspirates
Fine-needle aspiration and biopsy of specific organs and locations
Brain and spinal cord
Periorbital tissues
Soft tissues of the cervical region
Bone
Thorax
Abdomen
Liver
Gallbladder and biliary tract
Spleen
Pancreas
Gastrointestinal tract
Kidney
Adrenal masses
Urinary bladder
Prostate
Abdominal lymph nodes and masses
References
3 Point-of-care ultrasound
Afast and the fluid scoring system
Afast and associated five views
Patient preparation and positioning
Transducer selection and machine settings
The afast-applied fluid scoring system
Use of the afast-applied abdominal fluid scoring system in patients without hemorrhage
The importance of serial afast examinations with afs and recording positive locations
Summary of general decision making in different subsets of bleeding dogs and cats
Trauma cases
Nontrauma cases
When serial examinations should be performed
The afast views—right lateral, left lateral, sternal recumbency, and standing
The diaphragmatic-hepatic (dh) view
The splenic-renal (sr) view
The cysto-colic cc view
The hepato-renal extra umbilical view (hr5th view)
Additional view: Hepato-renal umbilical (hru) view (right lateral) or spleno-renal (sru) view (left lateral)
Additional clinical information obtained during an afast examination
The assessment of central fluid volume status via the caudal vena cava
Use of urinary bladder measurements in the cysto-colic view for urine volume estimation
Clinical significance of gallbladder wall edema
Tfast—thoracic focused assessment with sonography for trauma
Clinical questions that can be answered using tfast
Tfast—five acoustic windows
Patient preparation and positioning
Transducer selection and machine settings
The tfast views
The diaphragmatic-hepatic view
The bilateral chest tube site view
Pneumothorax and the lung point
The bilateral pericardial site views
Accurate tfast differentiation of pleural and pericardial effusion
Tfast echocardiographic views
Volume status
Evaluation of the lung periphery
Vet blue approach
Patient preparation and positioning
Transducer selection and machine settings
Vet blue and its associated nine acoustic windows
The basics of the vet blue study
Vet blue lung normal and abnormal ultrasound findings
Using vet blue and a regionally based approach to differential diagnosis
Vet blue basic—wet versus dry lung distribution
Vet blue advanced—shred, tissue, nodule, and wedge signs
Counting b-lines (ultrasound lung rockets)
Volpicelli strong positive counting of b-lines model
Vet blue and left heart failure in dogs and cats
Limitations of vet blue and lung ultrasound
Other ultrasound applications in the critical care setting
Global fast for patient monitoring
Global fast for detecting treatable forms of shock, cardiopulmonary resuscitation, and advanced life support
Global fast as a preanesthetic and perioperative monitoring tool
Other point-of-care ultrasound applications
Ocular
Musculoskeletal
Procedural assistance and guidance
Future of veterinary pocus
References
4 Abdominal ultrasound scanning techniques
Positioning of sonographer, patient, and equipment
Preparation of the patient
Getting started
Transducer motions
Liver
Falciform fat
Spleen
Stomach and duodenum
Pancreas
Kidneys
Adrenal glands
Small intestines and colon
Urinary bladder
Prostate
Uterus and ovaries
Abdominal lymph nodes
Abdominal vessels
References
5 Eye
Normal anatomy
Examination technique
Real-time b-mode examination
Corneal technique
Eyelid technique
Standoff pads
Scanning technique
A-mode examination
Normal ultrasound anatomy
Real-time b-mode examination
A-mode ultrasonography
Ocular ultrasonography in clinical practice
Intraocular masses
Intraocular neoplasms
Intraocular cysts
Intraocular inflammatory masses
Intraocular hemorrhage
Lesions localized by ocular structure
Cornea
Anterior chamber
Iridal lesions
Lenticular lesions
Dislocation
Cataracts
Vitreal lesions
Vitreal degeneration
Posterior vitreal detachment
Persistent hyperplastic primary vitreous
Retinal lesions
Retinal inflammation
Retinal detachment
Optic nerve pathology
Optic nerve congenital anomalies
Papilledema and optic nerve inflammation
Optic nerve neoplasia
Foreign bodies
Retrobulbar pathology
B-mode examination
Retrobulbar inflammation
Posttraumatic retrobulbar pathology
Retrobulbar neoplasia
Orbital and ocular vasculature and ocular perfusion
Color doppler evaluation of the ocular and orbital vasculature
References
6 Neck
General considerations
Carotid artery and jugular vein
Jugular vein thrombosis
Carotid arterial thrombosis and stenosis
Arteriovenous malformations
Neoplasia
Nerves
Thyroid gland
Thyroid cysts
Hypothyroidism
Thyroiditis
Hyperthyroidism
Thyroid nodules/masses
Parathyroid glands
Parathyroid hyperplasia and adenoma
Parathyroid carcinoma
Lymph nodes
Reactive lymph nodes and lymph node abscess
Metastatic neoplasia
Lymphoma
Salivary glands
Salivary cysts
Sialoliths
Sialitis, sialadenitis, and salivary gland abscess
Salivary gland neoplasia
Larynx and trachea
Tongue and esophagus
Cervical musculature
Miscellaneous neck masses
Neoplasia
Cysts
Hematomas
Cellulitis, abscess, and granuloma
References
7 Thorax
Scanning techniques
Normal anatomy
Body wall and lung surface
Mediastinum
Diaphragm
Pleural disease
Pleural effusion
Pleural surfaces
Pleural masses
Pneumothorax
Mediastinal disease
Inflammation
Mass lesions
Cystic lesions
Esophageal lesions
Pulmonary disease
Pulmonary neoplasia
Consolidation
Pulmonary abscesses
Pulmonary cysts
Atelectasis
Thoracic wall lesions
Diaphragmatic hernias and ruptures
Interventional procedures of the thorax
Thoracentesis
Fine-needle aspirations and biopsies of mass lesions
References
8 Echocardiography
Overview of echocardiography
Echocardiographic formats
Diagnostic information
Alternative imaging
Limitations of echocardiography
Instrumentation for cardiac studies
Transducers
Temporal resolution
System controls
Examination technique
Patient preparation
Transducer management
Other instrument controls
Core examination
Cardiac imaging: Nomenclature and display
Two-dimensional echocardiography
2d instrumentation
Artifacts
Long-axis images from the right side
Short-axis images from the right side
2d images from the left side of the thorax
Left apical images
Modified left apical images
Left cranial images
Other imaging positions
M-mode echocardiographic imaging
M-mode recording and instrumentation
Normal and abnormal m-mode findings
Left ventricle
LV measurements.
LV motion.
Mitral valve
Aortic valve/left atrium
Advanced 2d and 3d echocardiographic imaging methods
Contrast echocardiography
Transesophageal echocardiography
3d echocardiography
Cardiac doppler studies: Overview
Doppler principles
Overview of doppler modalities
Doppler examination techniques
Doppler transducers
Pulsed-wave doppler echocardiography
Signal aliasing
High pulse repetition frequency doppler echocardiography
Instrumentation in pulsed wave doppler
Instrumentation for tissue doppler imaging
Physiologic basis for pulsed wave doppler velocity spectra
Semilunar valves
Atrioventricular valves
Pulmonary veins
Atrial function assessed by pulsed wave doppler
Normal tissue doppler imaging
Clinical applications of pulsed wave doppler echocardiography
Continuous-wave doppler echocardiography
Hemodynamic quantitation using continuous wave doppler
Continuity relationship
Bernoulli relationship
Color doppler imaging
Color mapping
Color doppler instrumentation
Normal findings
Interpretation and quantitation
Limitations and pitfalls of cdi
Advanced image analyses
Assessment of cardiac chamber size
Limitations and suggested approach
Left atrial size and function
Atrial functional indices
M-mode methods
Long-axis methods
Short-axis methods
Volume estimates
Left ventricular size
M atrial functional indices
Models for estimating left ventricular volume
Subjective methods
Ratios in dogs
Measurements indexed to body size in dogs
Canine breed-specific reference values
Left ventricular measurements in cats
Left ventricular mass and detection of hypertrophy
Right atrium and ventricle
Great vessels
Cardiac chamber size: Clinical decision making
Ventricular function
Systolic ventricular function
Overview and practical considerations
Specific systolic function indices
M-mode measurements and indices.
2d indices.
Intervals of systole.
Doppler methods for assessment of LV function.
Myocardial strain, twist, and dyssynchrony.
Systolic function: Clinical decision making
Diastolic ventricular function
Overview and practical considerations
Specific variables in diastolic dysfunction
Isovolumetric relaxation time
Mitral inflow velocities
Tissue doppler imaging
Other variables
Diastolic function: Clinical decision making
Valvular regurgitation
Overview and practical considerations
Mitral regurgitation
Morphologic lesions and motion abnormalities
Cardiac remodeling in mitral regurgitation
Color doppler assessment of mitral regurgitation
Systolic function in mitral regurgitation
Spectral doppler findings in mitral regurgitation
Tricuspid regurgitation
Morphologic lesions
Doppler assessment of tricuspid regurgitation
Aortic regurgitation
Pulmonary insufficiency
Valvular regurgitation: Echocardiographic guidance of therapy
Valvular stenosis
Aortic stenosis
Echocardiographic guidance of therapy for aortic stenosis
Pulmonic stenosis
Echocardiographic guidance of therapy for pulmonic stenosis
Other comorbidities in pulmonic stenosis
Dynamic right ventricular outflow tract obstruction in cats
Atrioventricular and inflow obstruction
Echocardiographic guidance of therapy for inflow tract stenosis
Pulmonary hypertension
Clinical pathophysiology of pulmonary hypertension
Echocardiographic diagnosis of pulmonary hypertension
Echocardiographic guidance of therapy
Cardiomyopathies
Overview and practical considerations
Other features of cardiomyopathies
Feline hypertrophic cardiomyopathy
Diagnostic criteria
2d and m-mode examinations
Doppler studies
Feline restrictive cardiomyopathy
Other feline cardiomyopathies
Canine cardiomyopathies: Overview
Echocardiographic features of canine dilated cardiomyopathy
Cardiomyopathies: Echocardiographic guidance of therapy
Management of feline cardiomyopathy
Management of canine cardiomyopathy
Pericardial diseases and cardiac masses
Pericardial effusion
Cardiac-related neoplasms in dogs
Cardiomyopathies: Echocardiographic guidance of therapy
Congenital shunts
Overview and practical considerations
Atrial septal defects
Ventricular septal defects
Patent ductus arteriosus
Reversed patent ductus arteriosus
Patent ductus arteriosus: Echocardiographic guidance of therapy
References
9 Liver
Technique
Anatomy
Landmarks
Lobation and vascular anatomy
Size
Hepatic parenchyma
Gallbladder and biliary system
Doppler evaluation of the normal liver
Caudal vena cava and hepatic veins
Portal vein
Hepatic arteries
Focal or multifocal hepatic parenchymal disease
Nodular hyperplasia
Cysts
Hematoma
Abscess
Trauma
Liver lobe torsion
Neoplasia
Contrast evaluation of focal neoplasia
Diffuse disease
Decreased echogenicity
Increased echogenicity
Inhomogeneous echogenicity
Gallbladder and biliary tract
Congenital disorders
Gallbladder wall thickening
Biliary sludge and calculi
Cystic mucinous hyperplasia
Cholecystitis
Cholangitis
Gallbladder mucocele
Gallbladder rupture
Cholecystocentesis
Extrahepatic biliary obstruction
Neoplasia
Vascular abnormalities
Caudal vena cava and hepatic veins
Portosystemic shunts: Introduction
Congenital portosystemic shunts
Ultrasonographically assisted treatment of portosystemic shunts
Acquired portosystemic shunts
Prehepatic causes of portal hypertension
Hepatic artery abnormalities
Hepatic arteriovenous fistulas
References
10 Spleen
Examination technique
Normal anatomy and appearance
Focal or multifocal disease
Hematoma
Focal infarcts or necrosis
Abscess
Nodular hyperplasia
Neoplasia
Hyperechoic foci
Diffuse disease
Congestion
Splenic vein thrombosis
Splenic torsion
Infectious or inflammatory disease
Diffuse nonneoplastic disease
Diffuse neoplastic disease
Miscellaneous splenic findings
Doppler evaluation, harmonics, and contrast ultrasound
General medical considerations in patients with splenic disease
References
11 Pancreas
Indications for pancreatic ultrasonography
Examination technique
Normal anatomy and ultrasound appearance
Pathology
Nodular hyperplasia
Acute pancreatitis
Chronic pancreatitis
Pancreatic cysts
Retention cysts (true or simple cysts)
Pseudocysts
Pancreatic bladder
Pancreatic abscess
Pancreatic neoplasia
References
12 Gastrointestinal tract
Examination technique
Normal ultrasound appearance
Stomach
Small intestine and colon
Normal wall layers
Abnormalities of the stomach
Dilation
Pyloric obstruction
Gastric foreign bodies
Gastric wall thickening
Diffuse wall thickening
Focal wall thickening or mass lesions
Abnormalities of the small intestine
Corrugated bowel pattern
Dilation
Obstruction
Foreign bodies
Intussusception
Intestinal wall thickening
Diffuse wall thickening
Focal wall thickening or mass lesions
Doppler ultrasonography
Abnormalities of the cecum and colon
Intussusception
Wall thickening
Diffuse wall thickening
Focal wall thickening
References
13 Peritoneal fluid, lymph nodes, masses, peritoneal cavity, and great vessel thrombosis
Scanning technique
Peritoneal fluid
Intraperitoneal lymphadenomegaly
Masses
Mesentery
Free peritoneal air
Thrombosis of the abdominal aorta and caudal vena cava
References
14 Musculoskeletal system
Examination technique
Components of the musculoskeletal system
Tendons/ligaments
Normal findings
Abnormal findings
Tendon sheath/bursa
Normal findings
Abnormal findings
Muscle
Normal findings
Abnormal findings
Bone
Normal findings
Abnormal findings
Joints
Normal findings
Abnormal findings
Nerves
Normal findings
Abnormal findings
Ultrasound in the evaluation of lameness
Thoracic limb
Shoulder
Biceps brachii.
Supraspinatus tendon.
Infraspinatus and teres minor tendons.
Osteochondrosis of the humeral head.
Elbow
Elbow dysplasia.
Carpus
Tenosynovitis of the abductor pollicis longus.
Pelvic limb
Tarsus
Calcaneal tendon.
Tarsal soft tissues.
Osteochondrosis.
Stifle
Cruciate ligaments and menisci.
Patellar ligament and quadriceps tendon.
Coxofemoral joint
Hip dysplasia.
Iliopsoas muscle and tendon
Evaluation of swelling and wound involvement
Cellulitis and edema
Abscess and hematoma
Mass lesions
Wounds
Abdominal wall trauma/incisional swelling
Ultrasound-guided procedures
Aspiration of bone lesions
Ultrasound-guided arthrocentesis
Guide regenerative therapy
Foreign body retrieval
Guide regional anesthesia
References
15 Adrenal glands
Examination technique
Normal anatomy and ultrasound appearance
Left adrenal gland
Right adrenal gland
Normal adrenal gland size
Adrenal gland enlargement and masses in dogs
Reduced adrenal gland size
Adrenal gland pathology in the cat
Other adrenal lesions
References
16 Urinary tract
Kidneys and proximal ureters
Examination technique
Normal anatomy
Kidney echogenicity
Kidney and ureteral size
Absent or ectopic kidneys
Focal abnormalities of the renal parenchyma
Renal cysts
Solid masses
Complex masses
Focal hyperechoic areas in the renal cortex
Diffuse abnormalities of the renal parenchyma
Abnormalities of the renal pelvis and proximal ureter
Pelvic and ureteral dilatation
Pyelonephritis
Hydronephrosis
Congenital or idiopathic disorders
Uroliths and blood clots
Ruptured ureter and retroperitoneal disease
Subcapsular fluid or thickening and perirenal fluid
Perinephric pseudocysts
Doppler evaluation of the kidneys
Renal vein thrombosis
Renal artery occlusion and infarcts
Acute kidney injury
Obstructive versus nonobstructive pelvic dilation
Renal masses
Other potential uses of renal resistive index
Renal transplants
Distal ureters, urinary bladder, and urethra
Examination technique
Normal anatomy
Distal ureters
Antegrade pyelography for evaluating the distal ureters
Vesicoureteral reflux
Acquired ureterovaginal fistula
Ectopic ureter
Ruptured ureter
Ureteral obstruction
Ureteroceles
Disorders of the urinary bladder
Urinary bladder neck position
Urinary bladder volume
Urachal abnormalities and acquired diverticuli
Ruptured urinary bladder
Cystitis
Blood clots and hematomas
Cystoliths
Foreign bodies
Urinary bladder neoplasia
Disorders of the urethra
References
17 Prostate and testes
Examination technique
Normal prostate gland
Pathology of the prostate
Benign prostatic hyperplasia
Infection and inflammation
Neoplasia
Cysts
Paraprostatic cysts
Normal testes
Testicular pathology
Neoplasia
Orchitis
Atrophy
Torsion
Scrotum
Indications for specifically imaging the penis
References
18 Ovaries and uterus
Examination technique
Normal ovary
Ovarian disease
Cystic ovarian disease
Ovarian remnant syndrome
Neoplasia
Ovarian stump granuloma
Normal uterus
Uterine disease
Pyometra
Uterine stump pyometra
Neoplasia
Pregnancy diagnosis and fetal development
Fetal measurements and estimation of fetal age
Postpartum uterus
Abnormal pregnancy
Mammary gland
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z