Practical small animal ultrasonography. Abdomen

Medicina pediĂĄtrica en pequeĂąos animales

Presentation brochure

Practical Panagiotis Mantis

small animal

ultrasonography

Practical smAll AnimAl ultrasonography. Abdomen

Abdomen Panagiotis Mantis

Practical Panagiotis Mantis

small animal

ultrasonography

Practical smAll AnimAl ultrasonography. Abdomen

Practical small animal ultrasonography Abdomen

Abdomen Panagiotis Mantis

AUTHOR: Panagiotis Mantis.

FORMAT: 22 x 28 cm.

NUMBER OF PAGES: 160.

NUMBER OF IMAGES: 265.

BINDING: hardcover.

eBook included

RETAIL PRICE

78 â‚Ź

Practical small animal ultrasonography. Abdomen aims at being a quick visual guide to abdominal ultrasound in dogs and cats. The different chapters have been grouped according to the anatomical area being examined.

Each chapter contains the technique and normal appearance, examples of variations from normal, and technique exercises where applicable.

Quite a few images per chapter and videos with scanning techniques in the electronic version of the book enrich this practical work. A must for beginners in abdominal ultrasonography in small animals.

Practical small animal ultrasonography. Abdomen

Presentation of the book Diagnostic imaging techniques are increasingly important in veterinary medicine. Even if in the past they required a heavy investment, the truth is they are now more affordable and present in almost every vet practice.

Radiography was the first technique to arrive and ultrasonography has undoubtedly come to stay. In fact, ultrasonography may provide invaluable information to confirm presumptive diagnosis if, and only if, the clinician is able to perform and identify the normal ultrasonographic appearance of organs, is familiar with variations from normal, and knows how to interpret them.

The aim of this book is to provide veterinary surgeons with a visual guide to perform abdominal ultrasonographic examination in dogs, helping them to identify common disorders and assisting with the diagnosis and treatment.

Practical small animal ultrasonography. Abdomen

The author Panagiotis Mantis Panagiotis (Pete) Mantis is a Senior Lecturer in Radiology. He is an European Specialist in Veterinary Diagnostic Imaging and an RCVS Recognised Specialist in Diagnostic Imaging, and a Fellow of the Higher Education Academy. Dr Mantis is a regular author, speaker and tutor on the subjects of small animal radiology, ultrasonography, computed tomography and magnetic resonance imaging.

Pete Mantis graduated from the Faculty of Veterinary Medicine of the Aristotle University of Thessaloniki, Greece, in 1994. Between 1995 and 1998 he completed a small animal diagnostic imaging residency at the Royal Veterinary College in London. After completing his residency, Dr Mantis worked in first opinion practices and referral hospitals in London providing an emergency and diagnostic imaging consultancy service.

In 1999, and for a year, he was part time radiologist at the Department of Clinical Radiology, Faculty of Veterinary Medicine, Swedish Agricultural University in Uppsala. In 2000, he joined the Department of Veterinary Clinical Sciences at the Royal Veterinary College and currently he is a Senior Lecturer in Diagnostic Imaging.

His research covers all areas of imaging including MRI, CT, ultrasonography and radiology. Publications include retrospective and prospective studies. Dr Mantis is currently involved in a research project looking at ultrasonography of the canine and feline skin.

Communication services Web site Online visualisation of the sample chapter.

Presentation brochure in PDF format.

Author´s CV. Sample chapter compatible with iPad.

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Practical small animal

ultrasonography

Abdomen Panagiotis Mantis

PractIcal small anImal ultrasonograPhy. abdomen

Table of contents

1

Machine setup

chaPter

2

Holding the transducer and transducer movements

chaPter

3

Liver and gallbladder

chaPter

4

Spleen

chaPter

5

Gastrointestinal tract

chaPter

6 chaPter

VI

Pancreas

table oF contens

7

Kidneys

chaPter

8

Adrenals

chaPter

9

Urinary bladder

chaPter

10

Peritoneal cavity and lymph nodes

chaPter

11

Prostate

chaPter

12

Uterus and ovaries

chaPter

13

Overview of scanning the abdomen

chaPter

VII

PRACTiCAl smAll AnimAl ulTRAsonogRAPHy. AbdomEn

Scanning technique The animal is placed in right lateral recumbency with the head towards the ultrasound machine.

Left adrenal 1. Hold the transducer with the marker pointing towards the

3. Identify the left kidney (Fig. 1b).

head of the animal (Fig. 1a).

4. Fan the transducer towards the spine keeping it with a par2. Keep the transducer parallel to the spine.

allel orientation to the spine and maintaining the transducer at the level of the left kidney (Fig. 2).

a

b

Figure 1. (a) The transducer is positioned parallel to the spine with the marker facing the head of the animal. (b) An image of the left kidney as it is firstly identified when starting the search for the left adrenal.

Figure 2. The transducer is angled towards the spine keeping the tip in the same location (fanned up) while the parallel orientation to the spine is maintained.

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8

AdrenAl glAnds

CHAPTER

5. Without exerting pressure on the probe, fan slowly the probe ventrally in order to identify the aorta (Fig. 3a).

7. Look cranially to the corner between the renal artery and the aorta and continue to slowly fan the transducer ventrally while maintaining moderate pressure.

6. With minimal fanning motions of the transducer up and down, identify the renal artery as it originates from the aorta (Fig. 3b).

8. Identify the left adrenal; the normal adrenal appears as a “monkey nut” (Fig. 4).

a

b renal artery

Aorta

Figure 3. (a) The transducer is angled towards left kidney (down) keeping the tip in the same location (fanned down) while the parallel orientation to the spine is maintained. (b) The aorta and left renal artery are identified. From this point the transducer is fanned more ventrally slowly looking for the adrenal, cranial to the corner between the renal artery and the aorta.

Figure 4. Typical appearance of the left adrenal in the dog, having the characteristic “monkey-nut” shape.

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PRACTiCAl smAll AnimAl ulTRAsonogRAPHy. AbdomEn

Right adrenal Small and medium-sized dogs

1. Ask the assistants to tilt the animal at a 45° recumbency angle to table.

7. Identify the right kidney and, while keeping the orientation of the transducer, place the cranial pole of the right kidney in the middle of the screen (Fig. 6).

2. Keep the transducer with the marker pointing towards the head, in a sagittal orientation, parallel to the table and up to a finger away from the table (Fig. 5a).

3. Keeping the orientation of the transducer, place it just caudal to the rib cage, two thirds up from the ventral margin of the abdomen.

8. Keeping the orientation of the transducer, fan it dorsally until you identify caudal vena cava (the first big vessel at the top of the screen). A second big vessel may be seen on the screen below the caudal vena cava that is the aorta (Fig. 7).

9. As soon as you identify the caudal vena cava, stop fan4. Ask the assistants to place the dog in the proper right lateral recumbency.

5. Ask an assistant to place a hand behind the spine to support the animal while you press.

ning dorsally and start slowly fanning ventrally (towards the right kidney).

10. The right adrenal will be identified arrow-shaped near the caudal vena cava and, in many cases, slightly overlapping it (Fig. 8).

6. Press with your transducer towards the right kidney (towards the level of the last rib) (Fig. 5b).

a

b [Tail]

Transducer marker

[Head]

right ventral

[Head]

Figure 5. (a) Position and orientation of the transducer for identification of the right adrenal. (b) Pressure is applied to the transducer, while the transducer orientation and positioning is maintained, under the animal, in order to identify the right kidney.

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Figure 6. The right kidney is identified by applying pressure to the transducer. In some cases the duodenum and liver may also be seen.

duodenum

liver

right kidney

Figure 7. Fanning your transducer up-

wards, after the right kidney has been identified and the cranial pole has been placed in the middle of the screen, allows identification of the caudal vena cava (CVC). A second big vessel is visible on the screen below the CVC that is the aorta.

CvC Aorta

Figure 8. The “arrow-shaped� right adrenal is visible between by the arrows.

right adrenal

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PRACTiCAl smAll AnimAl ulTRAsonogRAPHy. AbdomEn

Large and giant-breed dogs The animal is placed on left lateral recumbency with the head towards the ultrasound machine. The hair is clipped at the level of the right kidney (last two intercostal spaces and slightly behind the last rib, just ventral to the spine); clipped area is extended ventrally up to the mid abdomen.

2. Slide the transducer ventrally until the caudal vena cava is

1. With the transducer in dorsal orientation, parallel to the

4. As soon as the caudal vena cava almost disappears from

spine, and the transducer marker pointing towards the head, the right kidney is identified (Fig. 9).

the screen, the right adrenal will appear: it looks like a “monkey nut� between the right kidney and the caudal vena cava (Fig. 11).

identified (Fig. 10). Do not press too hard since that may collapse the caudal vena cava and make it difficult to see.

3. Slightly fan the transducer dorsally towards the right kidney.

a

b

liver

[Head]

spine

right kidney

Aorta

Figure 9. (a) The transducer is positioned in dorsal orientation, parallel to the spine, and with the transducer marker pointing towards the head. (b) The right kidney and the aorta below are visible after the transducer is positioned as in Fig. 9a. Some dorsal fanning may be required to identify the aorta in some dogs.

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CHAPTER

a

b

right kidney

CvC

[Head] spine

Figure 10. (a)Â The transducer is fanned ventrally while maintaining the same orientation. (b)Â The caudal vena cava (CVC) is identified below the kidney on the screen.

Figure 11. The right adrenal, oblong in shape, is visible between the right kidney and the caudal vena cava (CVC).

right kidney CvC

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PrACTiCAl smAll AnimAl ulTrAsonogrAPHy. Abdomen

Normal appearance The normal adrenals appear hypoechoic to the surrounding fat (Figs. 4, 8 and 11). With a high-frequency transducer, the junction between the cortex and the medulla can be identified as a thin hyperechoic line. In some situations, the cortex can be clearly distinguished from the medulla, with the cortex being hypoechoic to the medulla.

The left adrenal and the right adrenal (when viewed with the technique described for large and giant dogs) appear elongated and bilobed in shape, resembling a monkey nut. The technique for small and medium-sized dogs is used for the right adrenal, which appears wedge-shaped (some described it as arrowshaped). The left phrenicoabdominal artery and vein pass dorsally and ventrally to the mid body of the adrenal gland, respectively.

The relative sizes have been reported for the normal canine adrenals. The maximum diameter of the left adrenal has been reported from 3 to 16 mm, while the maximum diameter for the right adrenal has been reported from 3 to 14 mm. The maximum diameter of the caudal pole of the adrenal gland appears to be the most reliable measurement in size.

The size of 7.4 mm as the maximum normal measurement has been reported to offer a reasonable combination of sensitivity and specificity. The measurements for the adrenals considered normal by the author are as follows: • Small dogs: maximum diameter of the caudal pole of the adrenal up to 8 mm.

• Medium-sized dogs: maximum diameter the caudal pole of the adrenal up to 10 mm.

• Large and giant breeds of dogs: maximum diameter of the caudal pole of the adrenal up to 12 mm.

In cats, the adrenals have been reported to have a maximum diameter of 4–4.6mm. The author considers normal a maximum diameter up to 6 mm for the caudal pole of the adrenal.

Otherwise, both poles of the adrenals should be of similar –but not necessarily identical– in size.

Table 1. Appearance of the adrenals and possible causes.

84

Adrenal appearance

Consider

Normal adrenals

normal Pituitary dependent hyperadrenocorticism

Uniformly, bilaterally enlarged adrenals

Pituitary dependent hyperadrenocorticism

Mass in one on both adrenals

Adrenal tumour

Adrenal mineralisation

Adrenal tumour

Small or difficult to find or having a maximum diameter of less than 3 mm

Addison’s disease exogenous steroid administration

Adrenals not visible

Technique Addison’s disease exogenous steroid administration

AdrenAl glAnds

8 CHAPTer

Variations from normal À Normal appearance and size of the adrenals do not exclude the possibility of pituitary-dependent hyperadrenocorticism (PDH).

À Bilaterally enlarged adrenals, with symmetrical enlargement of both the cranial and caudal pole, are indicative of pituitary-dependent hyperadrenocorticism. Pituitary-dependent hyperadrenocorticism accounts for approximately 80 % of dogs with hyperadrenocorticism. (Fig. 12).

À If one adrenal is enlarged or contains a nodule or mass, and the contralateral adrenal is difficult to be identified or it appears small or normal in size, this is suggestive of adrenal neoplasia (Fig. 13). Hyperadrenocorticism caused by a functional adrenal tumour accounts for approximately 20 % of dogs with naturally occurring hyperadrenocorticism. In some cases a nodule or mass can be identified in both adrenals. This can be compatible with bilateral adrenal neoplasia. In these cases, the invasion into the surrounding vessels is possible (especially the aorta for the left adrenal and the caudal vena cava for the right adrenal) and should be evaluated.

À In dogs with hyperadrenocorticism secondary to exogenous steroid administration, the adrenal glands may be difficult to identify, not visible, the or smaller than normal.

À Adrenal mineralisation (hyperechoic shadowing area within the adrenal gland) is suspicious for neoplasia in the dog, although it may also be seen associated with benign lesions.

À Addison’s disease cannot be diagnosed ultrasonographically. A reduction in the thickness and length of the adrenal glands compared to normal dogs has been shown. In a patient with clinical and laboratory findings compatible with Addison’s disease, difficulty in identifying the adrenals and/or the adrenals having a maximum diameter of less than 3 mm should be considered suspicious for Addison’s disease.

a

b

Figure 12. The caudal pole of a symmetrically enlarged left (a) and right (b) adrenal in a dog with pituitary-dependent hyperadrenocorticism.

Both adrenal glands are enlarged however they maintain their shape.

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Practical small animal ultrasonograPhy. abdomen

Figure 13. A large, mixed echogenicity mass has replaced the left adrenal in this dog with a left adrenal pheochromocytoma.

86

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