Ultrasonography Dr. LeeAnn Pack Dipl. ACVR. Normal Anatomy - Liver Size of liver –Assessed...
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Transcript of Ultrasonography Dr. LeeAnn Pack Dipl. ACVR. Normal Anatomy - Liver Size of liver –Assessed...
![Page 1: Ultrasonography Dr. LeeAnn Pack Dipl. ACVR. Normal Anatomy - Liver Size of liver –Assessed subjectively (rads are superior) Parenchyma –Homogenous,](https://reader033.fdocuments.in/reader033/viewer/2022061612/56649efd5503460f94c11b0c/html5/thumbnails/1.jpg)
Ultrasonography
Dr. LeeAnn Pack
Dipl. ACVR
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Normal Anatomy - Liver
Size of liver– Assessed subjectively (rads are superior)
Parenchyma – Homogenous, uniform– Interrupted only by portal & hepatic veins
Portal veins have echogenic walls Hepatic veins = black tubes Hepatic arteries are not seen
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Normal Anatomy - Liver
Echogenicity– Dog: Spleen > liver > kidney– Cat: Spleen = liver > kidney
Texture– More coarse texture than spleen
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Normal Anatomy
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Diaphragm
Portal vein
Normal
Abnormal
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Vasculature Portal veins
– More echogenic than hepatic veins due to surrounding fibro-fatty tissue
– Less visible with PSS, fibrosis, & cirrhosis
Hepatic veins
– Best seen cranially near diaphragm (emptying into vena cava)
– Walls not visible
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Vasculature
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Indications for US - GB
Thickened wall Stones Mucoceles Cholestasis Cholecystitis “Sludge” Icterus
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US Technique - GB
How to find it? Anechoic, round to
oval structure to right of mid-line
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Normal Anatomy - GB
Wall is thin echogenic line
Size of GB is variable
Cat GB is bi-lobed
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Feline Bi-lobed GB
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Enhancement
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Pathology - GB
Kiwi-shaped extensions– GB mucocele
Hyperechoic areas in wall– Edema– Acute inflammation
Large, hyperechoic sediment– Sludge vs Cholelith
Cholelith – usually cause acoustic shadowing
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GB Mucocele
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GB Mucocele
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GB Mucocele + perf
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Cholelith
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Sludge in GB
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Thickened GB Wall
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Normal Anatomy Spleen
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Normal
Splenic Hilus
Abnormal
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Ultrasound Technique - Spleen
Left side of body Head of spleen
– Under border of rib cage on left
Body & tail of spleen– Along left body wall– Ventral or lateral to left kidney
Scan sagittal & transverse
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Anatomy
Size of normal spleen variable– Assessed subjectively– Enlarged spleen may cross midline or
extend caudally to the bladder Parenchyma
– Homogenous, finely textured Echogenicity
– Dog: Spleen > liver > kidney– Cat: Spleen = liver > kidney
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Normal Spleen
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Anatomy
Capsule– Smooth, regular, VERY echogenic
Splenic veins– Only other structure normally visualized– Poorly visualized except near hilus
“Whale tail”
– Enlargement subjective Hilus
– Check for lymphadenopathy
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Splenic Hilus
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Non Homogenous
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Splenic Mass
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Neoplasia
Lymphosarcoma– Diffuse or focal/multifocal– Hypoechoic or hyperechoic– Can appear normal
Hematoma, hemangioma, hemangiosarcoma– Unable to differentiate– Focal– Hypoechoic, hyperechoic or mixed
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Lymphosarcoma
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Hemangiosarcoma
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Thrombosis
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Splenic Thrombus
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Myelolipoma
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U/S Technique - Bladder
Use high-resolution transducers (7-12 MHz)
Located very superficially Pressing too hard distorts the image
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Normal Anatomy - Bladder
Bladder wall thickness (1-2mm)– Dog: 1.6 mm– Cat: 1.7 mm
Wall thickness changes with bladder size
Ureters & urethra not visible unless filled with urine
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Pathology Intraluminal changes
– Urinary calculi – Gas bubbles – Cellular and crystalline debris– Blood clots
Bladder wall changes– Cystitis– Neoplasia– Polyps
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Urinary Calculi Calculi very hyperechoic Large calculi can cause acoustic
shadowing Ballotment doesn’t usually make calculi
move, but standing the animal will
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Urinary Calculi
Calculi
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Cystic Calculi
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Cystic Calculi
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Debris
Variable echogenicity Can become thick enough to form
confluent layer with bladder wall Vigorous ballotment will cause a
swirling pattern – looks like snow globe
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Cystitis Chronic cystitis leads to diffuse thickening
of wall Small mucosal masses sometimes present Muscular hypertrophy caused by chronic
partial lower urinary tract obstruction Emphysematous cystitis
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Cystitis
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Chronic Cystitis
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Neoplasia Single or multiple masses Irregularly shaped, broad-based hypo or
hyperechoic masses protruding into bladder lumen
Transitional cell carcinoma most common
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Neoplasia
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Neoplasia
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Indications for U/S - Kidneys
U/S very useful for evaluating:– Size, shape, position, echogenicity
In some cases, has replaced EU’s– Provides more info regarding morphology
Does NOT provide information about renal function
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U/S Technique - Kidneys
The left kidney is found just medial to the head of the spleen – Usually close to the body wall so start at body wall
and pull transducer medial
The right kidney resides in the renal fossa of the liver– Start at liver and proceed caudal along body wall
– Can be more difficult to find and more difficult to make a “pretty image”
– May be under the rib cage
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Normal Anatomy - Kidney Location
– Left kidney:caudal to stomach & caudo-medial to spleen
– Right kidney: within caudate process of caudate lobe of liver
Length (in sagittal plane): – Dog: depends on size & weight of the dog – Cat: 2.8-4.2 cm
Echogenicity– Cortex hyperechoic to the medullary portion
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Normal Anatomy - Kidney The cortex and medulla should be of equal
thickness and clearly defined Capsule is slightly hyperechoic Best to see renal pelvis on the transverse
view
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Normal Anatomy - Kidney
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Note the Capsule
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Lymphosarcoma
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Renal Infarct
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Polycystic Kidneys
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Polycystic Kidneys
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Lymphosarcoma
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Interstitial Nephritis
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Ethylene Glycol
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Large Renal Cyst
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Nephrolith
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Normal Sagittal
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Hydronephrosis
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Hydronephrosis
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Hydronephrosis
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Hydroureter
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Normal Transverse
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Hydronephrosis