Ultrasound Flashcards
What is POCUS?
Point of Care Ultrasound
= Real time instant US access and treatment or triage at that point )Vs delayed imaging procedure, followed by a read out several days/weeks later)
In reality, this is how equine vets have always done it
What does FLASH stand for? Which paper?
Fast Localised abdominal sonography of horses
‘Evaluation of a protocol for fast localised abdominal sonography of horses (FLASH) admitted for colic’ - Busoni et al, 2011
How good is the positive preductive value for FLASH for determining whether colic surgery for dilated turgid SI loops is required?
89% - very good
Also had a good negative predictive value of 81%
Where are the scanning locations for FLASH?
- Ventral abdomen
- Gastric window: LHS 10th ICS in middle third, then move 2-3 ICs cranial and caudal
- Spleno-renal window: LHS 17th ICS between dorsal and middle third
- L middle third of abdomen
- Duodenal window: RHS 14-15th ICS in dorsal part of middle third abdomen
- Right middle third of the abdomen
- Cranial ventral thorax: RHS just caudal to triceps muscle
What suggests strangulating lesions on US?
Dilated amotile loops SI
How many ICS should the stomach span over?
Up to 5 ICS
If >5 then strong suspicion of gastric impaction
What does it mean if can/can’t see the L kidney on US?
If can see it - definitely no nephrosplenic entrapment
If can’t see it - may be a nephrosplenic entrapment (not definitive)
What should the colon wall thickness be?
<3-4mm
What does the caecum look like on US? Where is it?
Occupies dorsal R paralumbar fossa and its apex extends all the way to the ventral abdomen
Usaully appears as a sacculated gas filled structure with greater motility than large colon
Where is the right dorsal colon in relation to the liver?
Immediately ventral and medial to the liver
What does it mean if see horizontally orientated vessels on RHS abdomen in region of caecum by US? How to differentiate from caecal vessels?
Strong indicator that they are mesenteric vessels, which should be on the other side of the caecum - this is suspicious of a right dorsal displacement or a full colonic torsion
Caecal vessels instead run longitudinally and shouldn’t be confused with mesenteric vessels
What are we looking for in the RHS cranial ventral thorax of FLASH?
To visualise the cranioventral abdomen, including the liver
Assess for presence of pleural fluid or diaphragmatic herniation into thoracic cavity
Small amounts peritoneal fluid is normal
What does T(FAST) stand for? What are the main things to look for with this? When to use?
Thoracic Focussed Assessment with Sonography for Trauma
Assess for:
- Pleural fluid?
- Pneumothroax?
- Pericardial effusion?
- Haemothorax?
- Fractured ribs?
Use in:
- Cases of increased respiratory effort in emergencies
- Trauma
Where to scan for TFAST?
Increased pleural fluid will accumulate around ventral lung fields first
Pneumothorax will collect dorsally
Can also include the window in the 3rd-4th ICS (scan through the triceps musculature to see more cranial ventral thoracic window)
Normal appearance of lung?
Bright white = pleural lining
On M mode - barcode appearance, with seashore appearance below (in photo - transverse image of caudodorsal lung fields)
What does a pneumothorax look like on B and M mode?
B mode - very similar to normal
M mode - can still see parietal pleura, but air accumulation prevents visualisation of visceral pleura and lose the grainy seashore pattern, instead have horizontal lines = stratisphere sign indicative of pneumothorax (in photo - transcerse image of caudodorsal lung fields)
What does FoCUS assess for?
What can be seen in this US image over a shoulder wound?
Hyperechoic areas = gas within the wound and around biceps tendon
What can be seen here of the ilial shaft?
Fracture
What can be seen here (wound over common digital extensor over fetlock joint)?
Left photo (dorsal transverse image) - fluid around extensor tendon and marked distension of fetlock joint with hyperechoic material withinjoint
Right photo (longitudinal image of same joint) - marked synovial thickening and proliferation within joint
Indicates synovial sepsis
Diagnosis?
Retinal detachment
Classical seagull sign - hyperechoic lines lifting off posterior part of the eye
