basic abdominal ultrasound
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Amanda Breyette, LVT
abreyette@uvsonline.com
Kristina Wilson DVM, DACVR
kwilson@uvsonline.com
BASIC ABDOMINAL ULTRASOUND
ANATOMY AND RECOGNIZING NORMALS
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The goal of performing an abdominal ultrasound is to obtain diagnostic quality images that can then be interpreted to answer a clinical question.
EX: Why is the patient vomiting or having diarrhea? Is there an underlying cause of renal disease? Is there an intestinal obstruction?
GOALS
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Always communicate prior history. Does this patient have a history of abdominal surgery- previous splenectomy? Hx of pancreatitis? Elevated liver enzymes? Spayed/Neutered?
HISTORY
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Fast your patient for 12 hours – no food, water ok
Hold urination for 1-2 hours prior to exam
Make sure ultrasound machine is labeled with correct patient – as the images are part of the medical record
Shaving
Far lateral - kidneys
Intercostal spaces in deep chested dogs
Choose appropriate probe size
The higher the frequency the lower the depth of penetration
Pick the highest frequency for your patient
Linear vs curved transducer
Indications
Uniform gain through entire image
Focus is on point of most interest
Depth
PREPPING FOR ULTRASOUND
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Sector Transducers (real time B-mode)
Electronic
Curvilinear array
Phased array
Linear array
Transducers
TYPES OF TRANSDUCERS
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Utilize your v-troughs
Start in dorsal recumbency
Change positions – left and right lateral recumbency
If your patient is comfortable they will stay still (or be more likely to stay still)
Use sedation when needed !!!
Torbugesic/Midazolam - 0.2-0.4mg/kg
Torbugesic can cause panting and can cause ileus
Acepromazine- splenomegaly
Dexmedetomidine- slow HR, big cava
Perform scan in same sequence every time
Systematic approach –
Organ to organ
START OF EXAM
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Depth
Always set to be able to see the deepest margin of organ being imaged
Focus
Set within region of most interest
Set where measurements are taken
Overall gain
Often left alone
May need to change if poor contact (increase) or if abdominal fluid (decrease)
TGC
near and far fields
Slides set to (b)right for deeper structures
KNOBOLOGY
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KNOBOLOGY
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Obese
Falciform fat
Depth
Thin
Nothing separating the organs
Landmarks are distorted
IMAGING ISSUES
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IMAGING ISSUES
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Always get 2 views
Sagittal plane view – marker faces cranial
Cranial is to the left on the screen
Transverse/ventral view – marker faces right.
Right intercostal view – marker faces dorsal
Left intercostal view – marker faces ventral
Radiologist needs to know right from left!!!
ORIENTATION
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Sagittal Plane
ORIENTATION
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Transverse Plane
ORIENTATION
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Left intercostal view
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Right intercostal view
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Sagittal View Transverse View
ORIENTATION
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ALWAYS LABEL AND ARCHIVE!
REMEMBER TO CHANGE LABELS AS YOU
GO
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Liver/Gallbladder
Stomach
Pancreas-left limb (cat)
Spleen
Left Kidney
Left Adrenal
Bladder
Urethra
Prostate
Colon
Right Kidney
Right Adrenal
Pancreas- right limb (dog)
Small intestine
Lymph nodes
CREATE A SYSTEMATIC APPROACH
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Located in the cranial abdomen
Intercostal in deep chested dogs
Always obtain the right dorsal intercostal view
Move from right to left to ensure you image the entire liver
Cranial is the diaphragm
Far left is the spleen
Caudal is the stomach
Make sure depth is set to see all diaphragm to get dorsal liver
Caudate lobe of liver, right dorsal intercostal
LIVER
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When evaluating liver size use your stomach as a landmark.
In the sagittal view, the ventral portion of left liver should not extend beyond the gastric body. The edge should also be tapered, not rounded.
The right liver should not extend caudal to the right kidney.
Usually mildly hypoechoic and coarse in comparison to the spleen and isoechoic to the cortex of the kidney.
Spleen-liver-renal cortex – SiLK
Falciform fat is isoechoic and coarse echotexture, located between the right and left liver lobes
LIVER
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Normal Cat Normal Dog
LIVER
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Right Dorsal Intercostal View Right Dorsal Intercostal View
LIVER
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Sagittal view – small liver Right Dorsal Intercostal View
LIVER
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Located in the right cranial abdomen within the right liver lobe
Varies in size
Becomes distended in anorexic or fasted patients
Bilobed in ~25% of cats – rarely in dogs
GALLBLADDER
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Wall thin and smooth
1mm in cats
2mm in dogs
Sludge
Reposition to confirm sludge vs. mass
Not common in cats
Almost always in dogs
Common Bile Duct (CBD) can be seen more easily in cats
GALLBLADDER
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Bilobed Common Bile Duct
GALLBLADDER
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Sludge
GALLBLADDER
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Standing Dorsal Recumbency
GALLBLADDER
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Located in mid cranial abdomen
Fundus, body, pyloric antrum – left to right
Gas distraction
Rugal folds and peristalsis
Measures 2-5mm in the dog and 1.7-3.6mm in the cat
Try to identify the pyloric sphincter
STOMACH
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Body Rugal Folds
STOMACH
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Gas distraction Pylorus
STOMACH
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Head, body and tail
Head and body located in the mid/left cranial abdomen
Tail can cross midline
“tongue” shaped
Margins are usually tapered
Hyperechoic with a fine echotexture in comparison of the liver/renal cortex
SPLEEN
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In large or deep chested dogs the head of the spleen can be more easily seen when the patient is in right lateral recumbency and imaged left dorsal intercostal.
The spleen can be folded on itself making it appear larger
Individual variations in size
1cm width at hilus in cats
< 3.5cm in most dogs
SPLEEN
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Cat Spleen Dog Spleen
SPLEEN
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Dog Spleen Cat Spleen
SPLEEN
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Should be symmetrical in size and shape
Oval (particularly in cats) or bean shaped
In cats the normal length is 3.0-4.5cm
In dogs the length varies due to size/breed
5cm in 50# dog
6cm in 60# dog
7cm in 70# dog
No kidney should be above 11cm no matter how big the dog is
Cortex is usually hypoechoic or isoechoic to the liver and hypoechoic to the spleen
Can be hyperechoic in overweight cats
Medulla is hypoechoic
Pelvis is not usually seen
Can be slightly distended in animals who are on fluids
KIDNEYS
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Located in the left cranial-mid abdomen
Can be difficult to visualize when patients have a full colon
LEFT KIDNEY
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Parasagittal Sagittal
LEFT KIDNEY
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Transverse Transverse
LEFT KIDNEY
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Hypoechoic to the surrounding fat
When using a high frequency transducer you can see the cortex and medulla
Can be mistaken for vessels – use your doppler
In cats the glands are short, ovoid or cylindrical
10-11mm long and ~4mm in width
In dogs the glands are elongated and have a more classic “peanut” shape
10-50mm long and up to 8mm in width
Measure both poles
ADRENAL GLANDS
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Located medial to the left kidney
Use your vasculature as landmarks
Lateral to the aorta
Cranial to the left renal artery
Dorsal/ventral to the left phreniocoabdominal artery and vein
Vein is easier to see and splits the gland into two poles
Fan ventral/dorsal until the gland is located
Asymmetry in poles could indicate a tumor
LEFT ADRENAL
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Small Dog Large Dog
LEFT ADRENAL
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Cat Cat
LEFT ADRENAL
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Dog Cat
LEFT ADRENAL
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Located on midline in the caudal abdomen
Best to image when the bladder it is moderately distended
Can place a u-cath and fill the bladder with 0.9% NaCL
Wait for it to fill naturally
Urine should be anechoic
Wall thickness decreases and the volume increases
Larger bladder = decreased wall thickness
In cats normal wall thickness is up to 1.7mm
In dogs it varies depending on side of the bladder
URINARY BLADDER
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Sagittal Cat Transverse Cat
URINARY BLADDER
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Sagittal Dog Transverse Dog
URINARY BLADDER
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Located in the caudal, left, cranial and right abdomen.
Left = descending
Right = ascending
Cranial = transverse
Often filled with gas and/or feces
Empty colon
Wall is hyperechoic
Transverse view almost looks like a tiny stomach
Has a thinner wall than the small bowel
Measures 2-3mm in the dog and 1.4-2.5mm in the cat
COLON
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Sagittal Transverse
COLON
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Empty Empty
COLON
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Neutered dogs
Hypoechoic and ovoid
<2cm in length
Intact dogs
Large, hyperechoic, uniform echogenicity, bilobed
Size varies with age
Similar echogenicity to spleen
PROSTATE
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Neutered Dog Intact Dog
PROSTATE
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Located in the right cranial/dorsal abdomen
More difficult to image
In large or deep chested dogs it can be more easily seen when the patient is in left lateral recumbency and imaged intercostal
RIGHT KIDNEY
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Sagittal Dog Transverse Dog
RIGHT KIDNEY
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Sagittal Large Dog Sagittal Cat
RIGHT KIDNEY
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Located in the right cranial quadrant close to the caudal vena cava
Fan ventral/dorsal through the CVC until the gland is visualized
Image intercostal
Use transverse approach
RIGHT ADRENAL GLAND
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Dog Cat
RIGHT ADRENAL GLAND
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5 different layers
Lumen, mucosa, submucosa, muscularis, subserosa/serosa
High frequency probe
Mucosa is the thickest layer
Measure form the outer aspect of the serosa and to the inner border of the mucosa
Descending duodenum
Located in the far right cranial/mid abdomen
Thicker than the remainder of small intestine
Measures 3-6mm in dogs and 2-2.5mm in cats
Duodenal papilla
SMALL INTESTINE
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Jejunum
Located in the mid abdomen
Measures 2-5mm in dogs and 2-3 mm in cats
Ileocecocolic Junction
Located in the right cranial abdomen
More easily visible in cats
Often difficult to identify due to gas collection in this area
Ileum is more easily identifiable due to its prominent and bright submucosal layer
Measures 2-4mm in dogs and 2.5-3.2mm in cats
Often thick muscular layer at the terminal part of the ileum
SMALL INTESTINE
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Wall Layering Wall Layering
SMALL INTESTINE
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Duodenum Cat Duodenum Dog
SMALL INTESTINE
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Duodenal Papilla
SMALL INTESTINE
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Jejunum Jejunum
SMALL INTESTINE
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Jejunum Jejunum
SMALL INTESTINE
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Ileocecocolic Junction Ileocecocolic Junction
SMALL INTESTINE
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Use your vessels as landmarks
Numerous lymph nodes within the abdomen and each have a different draining area
Mesenteric/Jejunal
Located along the cranial mesenteric artery and vein
Uniformly echogenic, isoechoic or slightly hypoechoc to the surrounding fat.
Thin hyperechoic capsule
Usually <4cm in cats and <5cm in dogs
Increased in puppies
Can be up to 1cm
-Medial iliac
Located at the caudal aortic trifurcation
More easily identifiable by using a lateral flank approach
Measure up to 7-8mm
LYMPH NODES
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Mesenteric/Jejunal Right Iliac
LYMPH NODES
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Has 3 portions
Right, left and body
Right lobe dorsomedial to the descending duodenum and ventral to the right kidney
The body is caudal to the pyloric region
The left lobe is dorsocaudal to the gastric antrum and crosses midline
Can be seen between the stomach and transverse colon
If you can see the stomach, spleen and left kidney in the same picture chances are the left pancreas is in there too
Homogeneous and is isoechoic or slightly hyperechoic
PANCREAS
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Dog Cat
PANCREAS
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Dog Cat
PANCREAS
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Side-lobe
Grating-lobe
Mirror-image
Acoustic enhancement
Acoustic shadow
ARTIFACTS
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Intense echoes from lateral lobes are mismapped as being within main lobe
Occurs with high reflective interfaces lateral to anechoic object in main beam
Correct by lower gain, lower frequency, change orientation or deeper focus
SIDE LOBE ARTIFACT
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SIDE LOBE ARTIFACT
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Acoustic enhancement Mirror image
ARTIFACTS
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REFERENCES
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MISCELLANEOUS
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MISCELLANEOUS
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”
“ QUESTIONS
QUESTIONS?
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