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