Thoracic Ultrasonographic

Examination

I- Lung and Pleura

Right side Left side

Applied Anatomy

Applied Anatomy

Lower airway Trachea

Incomplete tracheal rings

Tracheal bronchus

Left Lung – 2 lobes Divided Cranial Caudal

Right Lung – 4 lobes Divided Cranial Middle Caudal Accessory

(shaded)

Normal ultrasound of lung and pleura

Reverbration artifacts presents medially to the pleural layers due to presence of air inside the alveoli 3.5 MHz

Reverbration artifacts presents medially to the pleural layers due to presence of air inside the alveoli 5 MHz

Reverbration artifacts presents medially to the pleural layers due to presence of air inside the alveoli 6 MHz

Lung diseases diagnosed by

ultrasonography

1 -Pneumonia

Sonogram of a lung of a calf with pneumonia of the cranial lobe the normal lung tissue with reverberation artifacts on the left is distinctly delineated from the abnormal hypoechoic tissue with hyperechoic dot

Drenching pneumonia

2-Lung abscesses

Unripe lung abscesses appeared as anechoic areas surrounded by hypoechoic lines

Ripened abscesses appeared as hypoechoic areas

Old caseatyed abscesses appeared as echogenic circumscribed areas

3-Emphysema

Sonogram of pulmonary emphysema (5 MHz): the numerous echogenic bands (C) from the lung surface are comet-tail

Pleural diseases diagnosed by

ultrasonography

Pleurisy

Early stage of pleuropneumonia

Early stage of pleural effusion

Fibrinous pleuro-pneumonia

II- Heart (Echocardiography)

Applied Anatomy

• Right parasternal long axis view• Right parasternal short axis view• Left parasternal view

Techniques of echocardiograph

•4th intercostal space (ICS) midway between point of shoulder (POS) and point of elbow (POE)

•Scan plane marker dorsal and slightly cranial (1 o'clock position)

Right parasternal long axis view

B mode ultrasonography

Right parasternal long axis view

Right ventricular out flow view tract

RVOT

Left ventricular out flow view tract

LVOTFour chamber view

A- RVOT

B- LVOT

C- 4- chamber view

Right ventricular out flow view tractRVOT

Angle transducer towards the left 3rd ICS        

Should image:

1. the right atrium (RA)

2. tricuspid valve (TV),

3. right ventricle (RV),

4. pulmonic valve (PV)

5. pulmonary artery (PA)

RVOT

Left ventricular out flow view tractLVOT

Angle transducer straight across the thorax towards the left 4th ICS for left ventricular outflow tract (LVOT). Should image:

1-Right atrium (RA),

2-Tricuspid valve (TV),

3-Right ventricle (RV),

4-Interventricular septum (IVS)

5-Aortic valve (AV),

6-Aortic root (AR)

7-Left ventricle

7-Left atrium (LA).

LVOT

Four chamber view

Angle transducer caudally towards the left 5th ICS. Should image:

• Right atrium (RA)

• Tricuspid valve (TV)

• Right ventricle (RV)

• Interventricular septum (IVS)

• Left ventricle (LV)

• Mitral valve (MV)

• Left atrium (LA)

4 chamber view

Right parasternal short axis view

Rotate the transuducer 90 oSo that the scan plan is cranial and slightly ventral (4 o'clock)

Right parasternal short axis view

Left ventricularview Mitral valve view Aortic valve view

A- LV. view

B- Mitral valve view

C- Aortic valve view

Left ventricular view tractLVOT

Aim slightly ventrally to include the cardiac apex and papillary muscles.Should image the

1- right ventricle (RV)

2- interventricular septum (IVS)

3- left ventricle (LV)

4- dorsal aspects of the papillary muscles

5- left ventricular free wall

(LVFW).

LV view

Mitral valve view

Aortic valve view

Aim dorsally and slightly clockwise for AV Should image1- Tricuspid valve (TV),

2- Aortic root (AR)

3- Aortic valve (AV),

4- Left atrium (LA)

5- Left atrial appendage (LAA).

Aortic view

Left parasternal long axis view

• Should be done if:-LA or LV enlargement-MR, PR or AR-Atrial Fibrillation-Pericardial effusion-When all left heart cannot be visualized adequately from right side

Left parasternal long axis view

RVOT and PA LVOT and AR Mitral Valve

A- RVOT and PA

B- LVAT and AR

C- Mitral valve

RVOT and PA

Place transducer in left 3rd ICS and aim straight across the thorax and the scan plane marker facing cranially for PV Should image:

1- Pulmonary artery (PA)

2- Pulmonic valve (PV)

3- Tricuspid valve (TV)

4- Right ventricle (RV)

5- Aortic root (AR).

MV. View

Place the transducer in the left 5th ICS and aim straight across the thorax with scan plane marker facing dorsally and slightly cranially

M mode ultrasonography

RV.length (diastole)--- 3.8 cm

RV.length (systole)--- 2.7 cm

LV length (diastole)----11.9cm

LV length (systole)---- 7.35 cm

IVS d ------------------ 3.02 cm

IVS s ------------------ 4.55 cm

Cardiovascular diseases diagnosed by

ultrasonography

1 -Congenital diseases

1-Ventricular septal defect (VSD)

2- Atrial septal defect (ASD)

3- Parent ductus arteriosis (PDA)

VSD

1 -Aquired diseases

1-Pericardial diseases (pericarditis) 2- Myocardial diseases (myocardial degeneration) 3- Endocardial diseases (endocarditits)

1-Pericardial diseases (pericarditis)

Pericarditis appeared from left parasternal view at 4th intercostal space

2 -Myocardial diseases (myocardial degeneration)

3-Endocardial diseases (endocarditis)

Tricasped endocarditis