Imaging of ECC Patient

Question 1

Imaging modalities available for ECC patients

Answer 1

CT
MRI
Radiography
Endoscopy
Ultrasound

Question 2

Advantages of MRI

Answer 2

• Excellent for diagnosis of intracranial lesions and spinal lesions
• Excellent in equine for distal limb lameness
  Can image bone, tendon, ligament, joint capsule, etc.

Question 3

Disadvantages of MRI

Answer 3

Poor for both speed, utility and availability
Need report from radiologist

Question 4

Advantages of CT

Answer 4

Higher sensitivity and specificity than Ultrasound/radiography for detection of free fluid or gas, as well as organomegaly
Good diagnostically
Quick to obtain the images once in the machine
Full body CT <1 minute followed by processing time

Question 5

Disadvantages of CT

Answer 5

Slow to prep the patient (sedation/GA required)
○ Can be very slow to obtain a final report from a radiologist
Availability is limited in veterinary practice

Question 6

Advantages of Radiography

Answer 6

Good sensitivity and specificity for free gas
○ E.g. pneumothorax
More useful for lung pathology or mediastinal pathology and organ size
Obstructive GIT and urinary disease in small animals
Good for orthopaedic emergencies
○ E.g. especially in equine where decisions must be made quickly
○ Less useful in small animal
Widely available and relatively cheap
Easy to perform

Question 7

Disadvantages of Radiography

Answer 7

Moderate sensitivity and specificity for free fluid
○ E.g. pleural, abdominal, pericardial
Interpretation does require some experience
Often requires restraint/sedation/specific positioning which can be dangerous to the unstable patient
Allows limited assessment of thoracic and abdominal organs

Question 8

Advantages of Endoscopy

Answer 8

Excellent for upper respiratory distress in equine patients
Can be used for curative intervention

Question 9

Disadvantages of Endoscopy

Answer 9

Less useful in small animals due to the need for anaesthesia in unstable patients

Question 10

Advantages of Ultrasound

Answer 10

• This can safely be performed in unstable patients with minimal restraint
• Non-invasive, rapid, easy to interpret with minimal training when doing standardised protocols:
  AFAST/TFAST/VetBLUE/VPOCUS/GFAST in small animals
  FLASH in Equine
• Allows for abdominal organ assessment
  Parenchyma and size
• Allows for surface lung assessment
• Allows for cardiac assessment including volume status
• Good sensitivity and specificity for free fluid
• Moderate sensitivity and specificity for free gas
• Can be used for other soft tissue structures
  E.g. ligaments/tendons in equine
• Allows for interventions
  E.g. ultrasound guided centesis, or arterial blood sampling

Question 11

Disadvantages of Ultrasound

Answer 11

• Does not allow assessment of deep thoracic structures unless major pathology
• Does not allow assessment of airways
  Can’t assess if air filled

Question 12

Positioning considerations in EEC patients

Answer 12

Cardiovascular compromise
□ Might need to be positioned for VD radiograph
□ Dorsal recumbency might compress caudal vena cava, reducing venous return and CO
Respiratory compromise
□ Lateral recumbency might compress healthy lung to image diseased lung
Neurological compromise
□ Not raising patients head can increase intracranial pressure further

May increase oxygen requirement due to stress