Distal Limb Ultrasound
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Transcript of Distal Limb Ultrasound
Ultrasonographic Anatomy of the Equine Distal Limb
Lisa J. Zekas, DVM, DABVP –Eq, DACVRand Chess Adams, DVM, DACVR
Objectives
Brief introduction to ultrasound and the imaging procedure.
Be able to identify a transverse and a longitudinalimage.
Be able to apply the anatomy of the distal equine extremity to ultrasound images and identify structures.
Brief Introduction to Ultrasound
• Transducer produces sound waves and also receives reflected sound waves.
• Sound waves travel in a plane through tissue.• Sound waves are transmitted, absorbed or reflected by
tissues.• Computer forms image – in shades of gray.
From: Zagzebski, JA; Essentials of Ultrasound Physics, Mosby, © 1996
MusculoskeletalPalmar distal extremity
ReproductionUterine cysts
AbdomenLiver - cholelithiasis
Infected umbilicusEchocardiographyPericardial effusion
ThoraxPleuropneumonia
Patient Preparation
Clip the areaClean areaCoupling medium
alcoholcommercial gel
Imaging technique
Systematic organized approach – must be familiar with normal
Scan from proximal to distalEvaluate structures individuallyTransducer perpendicular to structureLimb should be weight bearing
Imaging TechniquesLabel images - patient info, directions and
locationTwo methods for location1. Zones2. Reference points
- cm distal to standard pointaccessory carpal bonepoint of hockpoint of ergot
i.e. 5 cm DACB
Ultrasonographic evaluation of structuresSize
• cross sectional area (cm2)• dorsal-palmar thickness
• medial-lateral width• proximal-distal length
From: Reef VB. Equine Diagnostic Ultrasound. WB Saunders, Philadelphia, PA. 1998
Ultrasonographic evaluation of structures
Echogenicity - Appearance using shades of gray-within structure itself-compared to other structures-compared to normal
anechoichypoechoichyperechoicisoechoic
Ultrasonographic evaluation of structures
Parallel fiber pattern (tendons and ligaments)
Transverse imagesPalmar (skin surface)
Dorsal
LateralMedial
Longitudinal imagePalmar (skin surface)
Dorsal
Proximal Distal
Imaging Techniques As in radiography – it is best when pathology can
be seen in both planes -(artifactual “lesions” can be created)
Longitudinal Transverse
Ultrasonographic Anatomy
From: Rantanen NW, McKinnon AO. Equine Diagnostic Ultrasonography Williams and Wilkins Philadelphia, 1998
Transverse
Longitudinal
Proximal metacarpal region
Ultrasonographic Anatomy
From: Rantanen NW, McKinnon AO. Equine Diagnostic Ultrasonography Williams and Wilkins Philadelphia, 1998
SDFTDDFT
ALDDFT (or ICL)
TIOM (or SL)Palmar surface of MCIII
SDFT
DDFT
ALDDFT (or ICL)
TIOM (or SL)Palmar surface of MCIII
Proximal
Dorsal
Medial
ForelimbHindlimb
Relation of SDFT to DDFT in proximal region
Ultrasonographic Anatomy
From: Rantanen NW, McKinnon AO. Equine Diagnostic Ultrasonography Williams and Wilkins Philadelphia, 1998
Transverse
Longitudinal
Mid 1/3 of metacarpal area
SDFTDDFT
ALDDFT (or ICL)
TIOM (or SL)Palmar margin of MCIII is indistinct
SDFTDDFT
ALDDFT (or ICL) – note how it thins and angles to join with the DDFT distally*.
*DISTAL
Dorsal
TIOM (or SL)
Palmar surface of MCIII
SDFTDDFTALDDFT joining into DDFT
SL splitting into branches - so no longer on midline
SDFTDDFT
ALDDFT
SL splitting into branches
Ultrasonographic Anatomy
From: Rantanen NW, McKinnon AO. Equine Diagnostic Ultrasonography Williams and Wilkins Philadelphia, 1998
Transverse Longitudinal
Transverse Longitudinal
SDFT
DDFT
Branch of Suspensory Ligament
SDFT
DDFT
MCIII
Suspensory Branches: imaged obliquely from medial and lateral sides
Transverse
LongitudinalLongitudinal at insertion on prox. sesamoid bone
Abaxial border oflat prox sesamoid bone
Longitudinal view of lateral suspensory branch
Lateral suspensory branch
Lateral suspensory branch
Ultrasonographic Anatomy
From: Rantanen NW, McKinnon AO. Equine Diagnostic Ultrasonography Williams and Wilkins Philadelphia, 1998
Transverse Longitudinal
SDFTDDFT
Margin of sesamoid bone
SDFTDDFT
Margin of sesamoid bone
Intersesamoidean ligament
Ultrasonographic Anatomy
From: Rantanen NW, McKinnon AO. Equine Diagnostic Ultrasonography Williams and Wilkins Philadelphia, 1998
Palmar Annular LigamentUsually difficult to identify unless thickened
Superfical Digital Flexor Tendinitis
Deep Digital Flexor Tendonitis
Suspensory ligament body desmitis
Normal (for comparison) Affected limb
Suspensory branch desmitis
Distal extremity Imaging
• Always image in two planestransverse and longitudinal
• Image from palmar / plantar aspect• Try to keep orientation consistent – label
images
Summary: ObjectivesBe able to identify a transverse and a longitudinalimage.
Be able to apply the anatomy of the distal equine extremity to ultrasound images and identify structures.
Questions?
Ultrasonographic Anatomy
From: Rantanen NW, McKinnon AO. Equine Diagnostic Ultrasonography Williams and Wilkins Philadelphia, 1998
Transverse: slightly off to lateral margin
Midpastern
PROXIMAL
DORSAL
LATERAL
Longitudinal
Effusion in tendon sheath
DDFT
Straight or superficial sesamoidean ligament
DDFTLateral branch of SDFTStraight or superficial sesamoidean ligament
Oblique or middle sesamoideanligament – (lateral aspect)
Palmar aspect P1
Palmar aspect of P1
PROXIMAL