Ultrasound Liver and Spleen Flashcards by Jennifer Sarkis

What is the scanning technique for the liver?

Use xyphoid cartilage as a reference.
Sagittal and transverse scanning.
**Intercostal approach for microhepatica or for deep chested breeds!

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Transverse ultrasound views images

Left to right.

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Sagittal images view..

Cranial to caudal.

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Normal liver:

Cranial boarder: Hyperechoic diaphragm.

Uniform, slightly coarse echo texture.

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Normal liver: vessels:

Portal: highly echogenic walls.
Hepatic veins: less distinct walls
Hepatic arteries are not visible!

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Normal liver: vessels:

Portal: highly echogenic walls.
Hepatic veins: less distinct walls
Hepatic arteries are not visible!
*View ultrasound liver and spleen lecture; slide 5

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Normal liver biliary structures:

Gall bladder is visible with various contents.
Intrahepatic bile ducts are not visible
Common bile ducts difficult to image in normal dogs, often visible in normal cats.

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Studies have shown liver and spleen on ultrasound..

Liver hypoechoic
Spleen hyper-echoic

*View ultrasound liver and spleen lecture; slide 6

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In felines the gallbladder maybe..

Bilobed!

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In felines the gallbladder maybe..

Bilobed!

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*View ultrasound liver and spleen lecture; slide 8

Appearance of sludge in the gallbladder.

Sludge/bile varies in appearance, especially in dogs.

Not organized**

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Gallbladder wall thickness in dogs:

up to 3 mm
accurate in predicating gallbladder disease, although thickness under <1 mm cannot rule out mild or chronic inflammation.

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Gallbladder wall thickness in cats:

thickness of >1 mm is accurate in predicating gallbladder disease, although thickness under <1 mm cannot rule out mild or chronic inflammation.

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What is an abnormal liver on ultrasound?

Changes in the shape, size, echogenicity and echo texture.
Focal, multifocal or diffuse changes.
Changes associated with the biliary system.
Vascular changes.

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A normal liver ultrasound does not..

RULE OUT HEPATIC DISEASE

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A normal liver ultrasound does not..

RULE OUT HEPATIC DISEASE

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Hyperechoic +/- hepatomegaly in dogs due to..

Steroid hepatopathy (cushings, iatrogenic)
Neoplasia (LSA)
Cirrhosis
Fatty liver (diabetes M)

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Hyperechoic +/- hepatomegaly in cats due to..

Fat (normal)
Lipidosis
Cirrhosis
Neoplasia

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Portal vessels in the liver are more difficult to see with..

Hyperechoic liver.

More easily seen (and see more) with hypoechoic liver.

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Hyperechoic liver

Compared to spleen, compared to falciform fat.
Compared against your own standard.
Portal vessels not easily seen.
*View ultrasound liver and spleen lecture; slide 12

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Hypo-echoic liver in dogs due to..

Neoplasia (lymphoma, mast cell), congestion, hepatitis, cirrhosis*

Hypo-echoic liver in cats due to..

Neoplasia (lymphoma, mast cell tumor), Cholangiohepatits, and congestion.

Hypo-echoic liver on ultrasound..

Compared to the spleen and falciform fat..
Compared against your own standard.
Portal vessels are visible.
Usually subjective.

*View ultrasound liver and spleen lecture; slide 14

Abnormal liver, focal lesions..

Focal lesions are non-specific.

Can be hypoechoic, isoechoic, hyperechoic, or mixed echogenicity.
Can be cysts, neoplasia, abscess, hematoma, complex cysts, nodular hyperplasia, granuloma

*View ultrasound liver and spleen lecture; slide 15, 16 and 17.
In these cases you want to sample.

Biliary lakes are also called..

``` Psudocystic lesions (biliary lakes) *View ultrasound liver and spleen lecture; slide 17 ```

Abnormal liver with focal lesions..

Need cultures or biopsies to diagnose what they are.. | *View ultrasound liver and spleen lecture; slide 18 & 19

Abnormal gallbladder ultrasound due to..

- Obsturctuion/biliary calculi - Contents - Wall thickening - Emphysematous chleocysytsis

Gallbladder luminal distention due to..

Obstruction, fasting (not emptying) and inflammation *View ultrasound liver and spleen lecture; slide 21

Gallbladder wall thickness with edema due to..

Often mimicked by free abdominal fluid which accumulates around the gallbladder. Choleocystis? or free abdominal fluid? *View ultrasound liver and spleen lecture; slide 22

*View ultrasound liver and spleen lecture; slide 23 | View chlecystoltith

Stone/minerals.

*View ultrasound liver and spleen lecture; slide 24 & 25 | Gallbladder mucocele

Unorganized sludge is OK, Organized sludge is impending mucocele. *Looks like kiwi

*View ultrasound liver and spleen lecture; slide 27

View emphysematous cholecystitis | Gas in the gallbladder and fluid.

*View ultrasound liver and spleen lecture; slide 27

View emphysematous cholecystitis | Gas in the gallbladder and fluid.

*View ultrasound liver and spleen lecture; slide 28

View mineralization of the bile ducts (calculi)

*View ultrasound liver and spleen lecture; slide 28

View enlarged bile ducts

*View ultrasound liver and spleen lecture; slide 29 and 30

Differentiae blood vessels from bile ducts.. | Ducts don't Doppler!!**

What are the various materials that can get caught in the common bile duct?

``` Calculus Fluid dilation Sludge Stenosis of the papillae at the duodenum *View ultrasound liver and spleen lecture; slide 31 ```

In cats a bile duct greater then what is considered to be consistent with extrahepatic biliary obstruction?

4mm | Probably the same in dogs.

*View ultrasound liver and spleen lecture; slide 34 | Portosystemic shunts

Very difficult to ID. | Portal vein and azygous vein.

Spleen scanning techniques

High frequency probe. Keep the transducer perpendicular to the skin. Gentle pressure Organ location in the abdomen may change.

Normal spleen location..

Variable location and size. Finer and more echogenic than the liver. Splenic vessels are identified entering the hilus. Splenic capsules are identifiable.

What is myelolipoma (spleen)

Normal fat globs around the splenic vessels.. | *View ultrasound liver and spleen lecture; slide 38

What is myelolipoma (spleen)

Normal fat globs around the splenic vessels.. *View ultrasound liver and spleen lecture; slide 38 & 39 Strongly hyperechoic nodules along the mesenteric border of the spleen, with our without distal acoustic shadowing, are a common incidental finding especially in older dogs. These lesions are myelopomas, appear deeper in the splenic parenchyma, commonly along vessels, very greatly.

Cat spleen normal limits measurements used by some..

Head: 1.7 cm Mid: 2.6 cm

Differentials for a large spleen?

Subjective Sedation Congestion Infiltration (benign or malignant)

Spleen too small?

???

Diffuse changes to the spleen (hypoechoic)

Torsion, congestion, neoplasia, hemolytic anemia, inflammation *View ultrasound liver and spleen lecture; slide 42, 43

Spleen multifocal lesions?

Nodular hyperplasia, hematomas, neoplasia, splenitis | *View ultrasound liver and spleen lecture; slide 45

Focal lesions of the spleen?

Hematoma, infarct, neoplasia, abscess, nodular hyperplasia. * View ultrasound liver and spleen lecture; slide 46 (benign hyperplasia) * View ultrasound liver and spleen lecture; slide 48

Splenic masses on ultrasound and radiographs..

Hemangiosarcoma, hemangioma and hematoma.. All look alike!! *View ultrasound liver and spleen lecture; slide 47 *other tumors, fibrous histiocytoma and mast cell tumors.

Vascular lesions of the spleen..

No flow with Doppler. Vascular thrombus Splenic torsion * ID the Doppler in the screen (green box) * View ultrasound liver and spleen lecture; slide 49 + 50