Ultrasound findings: the "Big 10" primary care veterinarians should recognize (Proceedings)

Article

Radiology is like standing on the outside of the building; it allows you to see the size, shape and contour of the building; ultrasound allows you to look into each room in the building i.e. the liver room, the gallbladder room, the pancreas room, the kidney room, the urinary bladder room etc.

For visualization of soft tissue structures, radiology and ultrasound are complimentary.

Analogy

Radiology is like standing on the outside of the building; it allows you to see the size, shape and contour of the building; ultrasound allows you to look into each room in the building i.e. the liver room, the gallbladder room, the pancreas room, the kidney room, the urinary bladder room etc.

When do I use radiology versus when do I use ultrasound?

     o Radiology—gas is our friend/fluid is our foe

     o Ultrasound-fluid is our friend/gas and bones are our foes

     o Too much fat is not so good with either imaging method.

The survey radiographic study enables you to appreciate the size and contour of "soft tissue" structures. The technology does not enable you to distinguish between fluid and solid soft tissue structures.

The survey ultrasound study allows you to appreciate the size, contour and composition of the soft tissue structures. The technology does not enable you to distinguish between fluid and soft tissue structures.

You cannot image through gas or bone with high frequency sound (ultrasound).

The survey ultrasound study is primarily used to assess soft tissue composition and in some cases function (echocardiogram) as well as guide you in biopsying "soft tissue" lesions. It has limited value in assessing bone-primarily restricted to the bone surface and it has no value in evaluating gas other than letting you know gas is present.

Lesions the primary care veterinarian should be able to define with their ultrasound unit:

Abdomen

     o "Free fluid"-volume and location

     o Large mass or "overt" change in the liver.

     o Markedly altered gallbladder

     o Large mass or "overt" change in the spleen

     o Large lymph nodes-golf ball size

     o Overt hemorrhage and/or edema in the pancreas

     o Overt mass in the bowel

     o Pathologic distention of the bowel

     o Marked thickening of the bowel wall

     o Pregnancy vs. pyometra

     o Large Calculi in the kidneys or urinary bladder

     o Large "mass" in the kidneys or urinary bladder/prostate/prepubic urethra

     o Cystic renal and hepatic disease.

     o Perinephric "cyst"

     o Hyrdonephrosis

     o Huge left adrenal gland

     o Marked alteration in size/contour of the abdominal and retroperitoneal viscera

Thorax:

     o Free fluid in the mediastinum, pleural space or pericardial sac

     o Mass vs. cyst in Mediastinum

     o Markedly altered pleural contour

     o Large mass right atrium

     o Large mass at heart base

     o Large thrombus left atrium

     o Overt dilated cardiomyopathy/volume overload/decreased contractility

     o Overt hypertrophic cardiomyopathy/hypertrophy

     o Overt enlargement of cardiac chamber/chambers

     o Overt attenuation of cardiac chamber/chambers

     o Overt displacement of abdominal viscera into the pericardial sac or pleural space

     o Large mass involving thoracic viscera adjacent to or involving the parietal pleura.

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