Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
117 Cards in this Set
- Front
- Back
|
DDX for reduced serosal detail
|
1. Emaciation
2. Neonate/Juvenile (less fat) 3. Peritoneal effusion/focal effusion 4. Carcinomatosis (causes effusion) 5. Poor radiographic technique - deep chested dogs on VD |
|
|
DDX for peritoneal effusion
|
1. Pure transudate - related to hypoproteinemia (loss from skin, kidney, GI or lack of liver production)
2. Modified transudate - right CHF, lymph obstruction/leakage, malignant effusion 3. Exudate - sterile or septic peritonitis 4. Hemorrhage - rupture, coagulopathy, trauma 5. Urine |
|
|
Best radiographic view to look for free gas in the abdomen, and why
|
Left lateral. Look for gas collecting just caudal to the diaphragm and this will eliminate confusion from gas in the fundus
|
|
|
Considerations for mass effect in midventral abdomen caudal to liver
|
Stomach, spleen, pancreas, mesentery, mesenteric lymph nodes, small intestine
|
|
|
DDX for mild hepatomegaly
|
1. Vacuolar hepatopathy - cushings, DM, steroid admin
2. Venous congestion (i.e. right heart failure) 3. Hepatic lipidosis 4. Hepatitis/Cholangitis (bacterial, viral, fungal) 5. Neoplastic infiltration |
|
|
DDX for severe hepatomegaly
|
1. Neoplasia
2. Fungal 3. Granulomatous 4. Abscess 5. Cysts |
|
|
DDX for microhepatica
|
1. PSS
2. Cirrhosis/fibrosis 3. Diaphragmatic hernia |
|
|
DDX for irregular hepatic shape/margin
|
1. Cirrhosis/fibrosis
2. Nodule/mass/cyst (benign regeneration, vacuolar hepatopathy, neoplasia, granuloma, cyst, polycystic disease, abscess in large animals, hematoma) |
|
|
DDX for mineralization in the liver
|
1. Branching mineralization - biliary tract mineralization; usually incidental
2. Amorphous/dystrophic mineralization - neoplasia, granuloma, abscess, hematoma (rare) |
|
|
DDX for gas in the liver
|
1. Hepatic abscess
2. Necrotic tumor 3. Emphysematous cholecystitis 4. Portal vein gas following GDV, hydrogen peroxide admin |
|
|
DDX for generalized splenomegaly
|
1. Redundant spleen (GSD) - no mass effect
2. Transient - anesthetics, barbituates, position/vessel occlusion 3. Extramedullary hematopoiesis (common and benign) 4. Torsion 5. Splenitis (bacterial, fungal, ehrlichia, hemobartonella) 6. Neoplasia (lymphoma, MCT) |
|
|
DDX for focal splenomegaly
|
1. Benign nodular hyperplasia
2. Extramedullary hematopoiesis 3. Hemangiosarcoma / Hemangioma / Hematoma 4. Granuloma 5. Abscess |
|
|
DDX for mineralization of spleen
|
Dystrophic mineralization d/t abscess, granuloma, neoplasia, hematoma
|
|
|
DDX for gas in the spleen
|
1. Torsion/thrombus
2. Abscess or necrotic tumor 3. Ascending from portal system (rare) |
|
|
DDX for mineralization of adrenal glands (not normally visible on rads)
|
Cats - abnormal, but usually benign
Dogs - Highly suspicious for neoplasia (adenoma, adenocarcinoma, pheochromocytoma, metastatic) |
|
|
When enlargement of medial iliac lymph nodes is seen radiographically, what else should be evaluated?
|
L5-L7- common region for metastasis
Areas the nodes drain: genito-urinary, perineal, peri-anal, pelvic limbs |
|
|
DDX for mineralization of "mesenteric lymph node"
|
Bates body - the result of a necrotic center of mesenteric fat that has mineralized or formed a mineral shell; occurs most commonly in cats and is completely incidental
|
|
|
Indications for esophagram (fluoro)
|
dysphagia, regurg, esophageal foreign body, stricture, masses, diverticula, perforation/fistula
|
|
|
What are the pros/cons for each of the contrast media?
|
Barium (preferred unless suspicion of perf) - Safer in lungs, but fatal if extravasated; sticks around longer, coats better, and provides better images. You cannot u/s or endoscopy after using
Non-ionic iodinated contrast - Less severe is extravasated, but also less safe in lungs. You can u/s or endoscopy after giving it, but it provides poorer images Ionic iodinated contrast - significant 3rd spacing so unsafe in dehydrated patients, significant pulmonary edema if aspirated; basically only use this d/t $ constraints |
|
|
What breeds are predisposed to megaesophagus?
|
GSD, Fox terrier, Miniature Schnauzer
|
|
|
What breeds are predisposed to sliding hiatial hernia?
|
Shar Pei, brachycephalic breeds
|
|
|
What radiographic view is best to identify GDV?
|
Right lateral
|
|
|
Normal GIT emptying times:
|
Stomach:
Food = 7-15 hours Barium = 4 hrs in dog, 90 min in cat S.I.: Dog ~ 2hr transit time w/ complete emptying in ~ 4hr, Cat ~ 1-2hr |
|
|
Parameters for normal diameter of small intestine
|
< 2 x the height of L4/L5 or < 2 x the width of 13th rib
|
|
|
What are the differences between functional and mechanical ileus? (radiographic and physiologic)
|
Functional ileus:
Ceased peristaltic contractions of the bowel d/t neuromuscular or vascular abnormalities (i.e. drugs, post-op, enteritis, peritonitis, pain, etc). Generalized fluid-filled or gas filled intestine. Mechanical ileus: Physical obstruction of the bowel Will see two separate populations of bowel; the fluid/gas filled bowel proximal to the obstruction and normal bowel distal to it. Often see "hairpin turns", "layered bowel loops", and "gravel sign" (compacted ingesta). If a linear foreign body may see plicated loops of bowel |
|
|
What are the contraindications for an upper GI study?
|
1. Obvious obstruction
2. Suspected GI perforation or unknown cause of pneumoperitoneum (avoid barium) 3. Following administration of anticholinergic drugs |
|
|
Normal "strange" findings on upper GI study
|
1. "Fuzzy" mucosa d/t villous detail
2. "Pseudoulcers" - outpouches along antimesenteric border of duodenum where contrast gets taken up into peyers patches 3. "String of pearl" - normal finding in cats d/t circular contractions 4. "Pseudostring" AKA mucosal fold sign - linear pattern where contrast isn't taken into a fold of mucosa that occurs d/t an empty intestinal tract |
|
|
Abnormal findings of an upper GI study
|
1. Ulcer - outpouching of contrast in an area NOT along antimesenteric border of duodenum
2. Foreign body - may see void in contrast, or contrast may coat item 3. Enteritis - "string like" appearance to contrast d/t inflammation and narrowing of intestinal lumen; also usually see decreased transit time (more rapid) 4. Flocculation - clumping of barium particles d/t alteration in GI environment (i.e. increased gastric acid, fats, GI mucous, etc) 5. Intra-peritoneal barium = bad |
|
|
Parameters for normal diameter of large bowel
|
< length of L4
|
|
|
Parameters for diagnosis of megacolon
|
Animal w/ history of chronic constipation/obstipation that is unresponsive to medical treatment AND large, distended, fecal-filled colon on rads
In cats: > 1.5x length of L5 |
|
|
DDX for colonic stricture
|
1. Mural masses (neoplasia, granuloma, etc)
2. Extramural masses (lymph node, prostate, etc.) 3. Inflammation (colitis) 4. Spasm (may or may not be associated w/ colitis); looks like "string of pearls" in colon |
|
|
DDX for generalized increase in colonic size
|
1. Megacolon
2. Constipation |
|
|
DDX for localized increase in colonic size
|
1. proximal to obstruction
2. proximal to mass lesion 3. proximal to intussusception (homogenous soft tissue opacity of colon w/ meniscus sign) |
|
|
What structures are normally contained within the retroperitoneal space?
|
Kidneys, ureters, urinary bladder, adrenal glands, aorta, caudal vena cava, part of esophagus, rectum
|
|
|
What radiographic view is best to view the kidneys?
|
Right lateral
|
|
|
Where are the kidneys normally located?
|
Dog:
Right: T13-L1, Left: L2-L4 Cat: Right: L1-L4, Left: L2-L5 |
|
|
Parameters for normal kidney size
|
~ 2.5-3x length of L2 on VD view
Slightly bigger in dogs up to 3.5x and smaller in old cats down to 2x |
|
|
DDX for diseases of the kidney that can occur without changing the radiographic appearance
|
1. Amyloidosis
2. Familial renal disease 3. Acute glomerulonephritis 4. Acute pyelonephritis 5. Acute renal toxicity (drug, plant, infectious, ethylene glycol, etc) 6. Early stages of other diseases |
|
|
DDX for missing kidney
|
1. Hypoplasia
2. CKD 3. Retroperitoneum changes 4. Structure superimposition 5. Nephrectomy 6. Aplasia/agenesis (contralateral enlargement) 7. Ectopic kidney |
|
|
DDX for kidney of normal size but with an irregular shape and margin
|
Focal irregularity
1. infarct 2. abscess General irregularity 1. Chronic pyelonephritis 2. polycystic kidney disease |
|
|
DDX for a small kidney with a regular shape and margin
|
1. Hypoplasia
2. Glomerulonephritis 3. Amyloidosis 4. Familial renal disease (affects both kidneys) |
|
|
DDX for a small kidney with irregular shape and margin
|
1. End-stage renal disease (usually affects both kidneys)
2. Dysplasia (usually affects both kidneys) |
|
|
DDX for a large kidney with a regular shape and margin
|
1. Compensatory hypertrophy
2. Glomerulonephritis 3. Round cell neoplasia 4. Hydronephrosis 5. Amyloidosis 5. Granulomatous disease/FIP 6. Perirenal pseudocyst 7. Perinephric abscess |
|
|
DDX for a large kidney with irregular shape and margin
|
Focal
1. Neoplasia (primary renal adenocarcinoma or met) 2. Hematoma 3. Perirenal pseudocyst Diffuse 1. Polycystic kidney disease 2. Round cell neoplasia 3. FIP 4. Granulomatous/fungal disease |
|
|
DDX for increased radiopacity of the kidney
|
Focal
1. Artifact 2. Nephrolith 3. Dystrophic mineralization (incidental, chronic hematoma, granuloma, abscess, neoplasia, osseous metaplasia) Diffuse (nephrocalcinosis) 1. Chronic renal disease 2. Ethylene glycol toxicity 3. Cushings 4. Hyperparathyroidism 5. Hypervitaminosis D 6. Hypercalcemia syndromes 7. Nephrotoxic drugs (gentamicin) |
|
|
What does excretory urography tell you about the function of the kidneys?
|
It tells you if they are functioning, but not how well
|
|
|
What are the contraindications for performing excretory urography?
|
Contradindicated in dehydrated animals
|
|
|
What are the 4 phases of excretory urography?
Which ones change with contrast induced renal failure? Parameters of renal pelvis/ureter diameter? |
1. Vascular nephrogram - phase in which contrast medium is in the vasculature and you see opacification of the renal artery. Happens very quickly and we usually miss this phase
2. Tubular nephrogram - opacification of the renal parenchyma which normally occurs immediately and is uniform and symmetric. Should diminish over time with most dogs having none left after 2 hours. This phase is prolonged with contrast induced renal failure. 3. Pyelogram - Opacification of renal collecting system usually occurs in 3-5 minutes. Delay of this phase occurs with contrast induced renal failure. Renal pelvis should be <2mm 4. Ureteral phase - opacification of the ureters occurs in conjunction with the pyelogram. Peristalsis is normal so may have to take several images to r/o stricture. Proximal ureters should be < 3mm |
|
|
When performing excretory urography, what determines the level of opacification?
|
Dose administered, hydration status of patient, renal perfusion, GFR, tubular reabsorption of water
|
|
|
What changes will be seen on excretory urography when pyelonephritis is present?
|
Pelvic and proximal ureteral dilation + short, blunted pelvic diverticula
|
|
|
What changes will be seen on excretory urography when hydronephrosis is present?
|
Severe pelvic, diverticula, and ureteral dilation due to obstruction
|
|
|
Which uroliths are radiopaque and which are soft tissue opacity?
|
Radiopaque:
1. Calcium oxalate 2. Triple phosphate/struvite 3. Calcium carbonate 4. Silicates Soft tissue opacity: 1. Cystine 2. Urates 3. Xanthine |
|
|
What are the contraindications to performing contrast cystography?
|
Confirmed or suspected emphysematous cystitis (since infusing volume will increase the chance for rupture)
|
|
|
What are the benefits to performing positive contrast cystography? What about double contrast?
|
Positive contrast - bladder size, shape, location, tears/ruptures, abnormal communications
Double contrast - bladder wall mucosa (mucosal margin, serosal margin, bladder wall thickness), intraluminal filling defects (neoplasia, calculi, blood clots) |
|
|
Parameters for normal size of the prostate gland
|
In an intact animal, should not exceed 2/3 width of pelvic canal on VD or 1/2 width on lateral
|
|
|
DDX for enlargement of the prostate gland
|
1. BPH
2. Prostatitis 3. Prostatic abscess 4. Paraprostatic cysts 5. Neoplasia (uncommon, but it is the only one that affects both neutered and intact animals) |
|
|
When will you see uterine changes in the pregnant animal radiographically?
|
Dogs:
Uterine enlargement - 30 days, Mineralization - 45 days Cats: Uterine enlargment - 25-35 days, Mineralization - 36-45 days |
|
|
What are the radiographic signs of fetal death?
What is the earliest method of diagnosing fetal death? |
1. Disparity in size and opacity of fetus
2. Emphysematous fetus and uterus 3. Overlapping/involuting calvarium ("Spalding sign") 4. Macerated fetus 5. Mummification of fetus Earliest method = loss of heartbeat on ultrasound |
|
|
What are the differentials for an enlarged uterus?
|
1. Pregnancy
2. Pseudopregnancy 3. Pyometra 4. Hydrometra 5. Mucometra 6. Uterine torsion 7. Uterine entrapment 8. CEH |
|
|
What type of ultrasound creates a 2-dimensional image of the anatomy?
|
B-mode (brightness mode)
|
|
|
What type of ultrasound creates a moving image of what is happening along a single scan line over time?
|
M-mode (motion mode)
|
|
|
What type of ultrasound can perform simultaneous B-mode and pulsed wave or continuous wave Dopplar?
|
Duplex ultrasound
|
|
|
Term - the inherent ability of a tissue to hinder/retard the movement of sound waves
|
Acoustic impedance
|
|
|
Term - the speed of sound within a given medium
|
Propagation speed
|
|
|
Propagation speed is equal to:
And the only one of those variables that we can control is: |
1. Frequency x Wavelength
2. Frequency |
|
|
Term - the distance between the same points on successive waves of sound
|
Wavelength
|
|
|
Term - the number of cycles per second of a sound wave
|
Frequency
|
|
|
Term - the minimum distance in the beam direction between two reflectors which can be identified as separate echoes
|
Axial resolution
|
|
|
Term - the minimum distance perpendicular to the beam direction between two reflectors which can be identified as separate echoes
|
Lateral resolution
|
|
|
Term - the gradual loss of intensity of sound energy as it propagates through a medium; seen as decreasing brightness in the deeper image
|
Attenuation
|
|
|
As you increase the frequency of an ultrasound, what will happen to the propagation speed, wavelength, axial resolution, attenuation, and penetration/depth?
|
Propagation speed = same
Wavelength = decrease Axial resolution = increase Attenuation = increase Penetration = decrease |
|
|
What type of probe has a flat rectangular appearance and creates an image with a flat top and rectangular shape?
|
Linear probe
|
|
|
What type of probe has a flat rectangular appearance and creates an image with a flat top and pie shape?
|
Vector probe
|
|
|
What type of probe has an arch shape and creates an image with a curved top and pie shape?
|
Curvilinear probe
|
|
|
What type of probe has a small pointed trapezoid shape and creates an image with a pointed top and pie shape?
|
Phased probe
|
|
|
Which types of ultrasound probes give the highest and lowest frequencies?
|
Highest - linear probe
Lowest - curvilinear probe |
|
|
What is the echogenic relationship between organs?
|
From hyperechoic ----> Hypoechoic:
Fat (i.e. renal pelvis) > Spleen > Liver > Kidney cortex > Kidney medulla NOTE: The renal cortex can be isoechoic or even hyperechoic to the liver and still be considered normal. It is generally slightly brighter in cats d/t fat storage |
|
|
How can you change the settings of Dopplar to allow for visualization of different amounts of flow?
|
Adjust the pulse repetition frequency, or "scale"
|
|
|
With color flow Dopplar, what do the colors indicate? What does the shade of that color mean?
|
Blue flow is away from you (hepatic veins) and red flow is toward you (portal veins)
BART Shade indicates velocity of flow |
|
|
With power flow Dopplar, what does the shade of the color mean?
|
Indicates amount of flow (# of RBCs); there is no indication of direction or velocity but it is much more sensitive to low flow (useful for thrombus/torsion to see if there is any blood supply at all)
|
|
|
What is spectral Dopplar?
|
Think of this as like M-mode for Dopplar. It gives a graphic display of flow over time; useful for blood pressure.
spectral Dopplar of an artery will have peak-trough pattern, while that of a vein will be fairly consistent |
|
|
Name and give the cause of an artifact which appears as an echogenic surface with a dark acoustic shadow deep to it
|
Clean shadow
Ultrasound is reflected and absorbed by the material preventing the ultrasound from penetrating any deeper; bone/mineral will cause clean shadow, as will fecal material in the colon, foreign bodies, etc. |
|
|
Name and give the cause of an artifact which appears as a series of closely spaced, discrete echoes that weaken with increasing depth d/t attenuation, forming a streak-like image which is hyperechoic proximally and more hypoechoic distally
|
Comet tail
This originates between two anatomic reflecting surfaces which have large differences in acoustic impendance. Many comet tails next to each other create a “dirty shadow” |
|
|
Name and give the cause of an artifact which appears as equally spaced, parallel bands which get weaker as they go deeper d/t attenuation; creates the illusion that there are additional reflectors that are not real
|
Repetition artifact
a reflection of the ultrasound beam between a strong reflector and the probe (over and over again) |
|
|
Name and give the cause of an artifact which appears as a bright white echo which starts proximally and extends all the way to the bottom of the screen without attenuating
|
Ring down artifact
d/t a resonance phenomenon involving a collection of bubbles (bubble tetrahedron). A bugle-shaped fluid collection forms between the 4 bubbles and, when struck by an ultrasound pulse, acts as an oscillator becoming a continuous secondary source of ultrasonic waves (think of a tuning fork); commonly seen in lung diseases |
|
|
Name and give the cause of an artifact which appears as a duplicate structure placed deep to a highly reflective surface (i.e. seeing more “liver and/or gallbladder” on the thoracic side of the diaphragm)
|
Mirror image artifact
ultrasound waves bounce off of highly reflective tissue into the body, then bounces off of the other structure and back to the highly reflective tissue, which then reflects the ultrasound back to the transducer again. The machine isn’t smart enough to figure out the extra reflective step, so it puts all the echoes in a straight line. |
|
|
Name and give the cause of an artifact which appears as increased echogenicity of tissue deep to a fluid-filled structure (will look like the fluid-filled structure is outline with a bright white line)
|
Distal acoustic enhancement
decreased attenuation of the ultrasound waves passing through fluid compared to how much soft tissue the computer “thinks” the wave should have passed through at that depth |
|
|
How can the ultrasound operator correct distal acoustic enhancement?
|
Adjust the "time-gain compensation" to decrease the gain in the far field
|
|
|
What two conditions should you avoid diagnosing by ultrasound, and why?
|
Diaphragmatic hernia - mirror image artifact
Ruptured urinary bladder - urinary bladder pseudolesion d/t a type of edge shadowing |
|
|
Name and give the cause of an artifact which appears as “pseudo-sludge” within an organ/gives the false impression of material within an organ, most commonly the urinary bladder or gallbladder
|
Slice thickness artifact
part of the beam contacts the wall of the curved organ before the other part of the beam does, causing the computer to average the echogenicities of the contents of the organ with that of the interfacing organ (i.e. gall bladder contents average with liver tissue) and place that “new echogenicity” into the image in the space between where the first half of the beam made contact and the second half of the beam made contact. |
|
|
How can you tell if "sludge" within an organ is d/t artifact or if it is real?
|
1. Look at the organ from a different angle
2. Have the animal stand up or roll over because true sludge should move around |
|
|
Name and give the cause of an artifact which appears as something in the middle of the image that isn’t real; the image will move when seen from different angles or planes; commonly seen in the urinary bladder b/c the colon is highly reflective;can sometimes be indistinguishable from slice thickness artifact
|
Grating lobes
ultrasound waves propagate out from the transducer in directions other than the primary beam, but the computer thinks that the echoes created from these waves are a part of the primary beam |
|
|
Name and give the cause of an artifact which appears as black lines which go down distal to the edges of a curved structure
|
Edge shadowing
occurs as the ultrasound beam enters a circular area of higher or lower propagation speed, and is a result of refraction and reflection. The computer isn’t smart enough to figure out what has happened and since the beam deep to the structure has been misplaced, the computer interprets it as a lack of echo and makes it black. |
|
|
Name and give the cause of an artifact which occurs in animals with peritoneal effusion where the urinary bladder appears to be ruptured because a part of the bladder wall is “missing”
|
Urinary bladder pseudolesion
a special kind of edge shadowing in which the shadow cast hides a portion of the bladder wall |
|
|
Name and give the cause of an artifact which appears as a black line that begins all the way at the top of the screen and goes to the far field
|
Loss of contact artifact
not enough lubricating jelly or not a good enough haircut |
|
|
Name and give the cause of an artifact which causes a structure to become more or less echogenic depending on the angle of the ultrasound beam in relation to the reflective surface
|
Anisotropy
a property of being directionally dependent; the highest amplitude echoes occur when the ultrasound beam in 90° to the reflector; at other angles, some of the beam is reflected in directions that don’t take it back to the transducer so the resulting echo is not as “loud” and the image is less echogenic |
|
|
Name and give the cause, and the solution, of an artifact that appears with spectral Dopplar in which the tops of the peaks get cut off and will appear on the wrong side of the baseline; with color flow Dopplar, will appear as the wrong color
|
Dopplar aliasing
the flow velocity has exceeded the computer’s ability to measure it Correction: (with either type of Dopplar) adjust the baseline to be lower, or increasing the pulse repetition frequency (scale) to measure faster flow |
|
|
Name and give the cause of an artifact which appears as very strange spots of color with color flow Dopplar, and with spectral Dopplar it will sound like frying eggs rather than blood flow through a vessel
|
Twinkle artifact
this occurs when Dopplar comes in contact with things that are mineralized; can be useful in identifying mineralization in prostate, gall bladder, urinary bladder, etc. |
|
|
How do you differentiate the two common ultrasound views of the liver?
|
Long axis / saggital view
Patient's head is to the left of the screen, diaphragm cuts diagonally across the screen from craniodorsal to caudoventral; if gall bladder is seen, it will be to the right of the diaphragm on the image Short axis / transverse view patient’s right side is on the left of the screen, diaphragm runs across the bottom of the image; if the gall bladder is seen, it will appear on the left side of the image (right side of the liver) |
|
|
What ultrasonographic changes of the abdomen might indicate right heart failure?
|
1. Peritoneal effusion
2. Enlargement of hepatic veins 3. Changes in Dopplar flow in hepatic veins; may be blue during diastole, but turn red during systole |
|
|
DDX for cavitary ultrasonographic lesion(s) in the liver?
|
1. *cysts
2. *neoplasia (hemangio-, others w/ necrotic centers, benign such as biliary cystadenoma in cats) 3. Abscess 4. Hematoma |
|
|
DDX for solid ultrasonographic lesion(s) in the liver?
|
1. Nodular hyperplasia (very common)
2. Neoplasia (hepatoma, hepatocellular carcinoma, round cell, others) |
|
|
DDX for diffusely hyperechoic liver on ultrasound?
|
1. *Vacuolar hepatopathy (cushing, DM, steroids, hepatic lipidosis, glycogen)
2. Hepatitis 3. Chronic cholestatic disease 4. Toxins (usually chronic) 5. Fibrosis/cirrhosis (usually also microhepatica) 6. Atypical neoplasia |
|
|
DDX for diffusely hypoechoic liver on ultrasound?
|
1. Lymphoma
2. Leukemia 3. Amyloidosis 4. Hepatitis 5. Toxic hepatopathy 6. Congestion 7. Young age 8. Glycogen depletion |
|
|
DDX for mixed echogenicity changes in liver on ultrasound?
|
1. Metastatic/multifocal neoplasia
2. Hepatocutaneous syndrome - hypoechoic nodules with hyperechoic liver interspersed between (like a bright liver with bubbles in it) 3. Cirrhosis - identical to HS above |
|
|
DDX for thickened gall bladder wall?
|
1. Cholecystitis
2. Cholangitis 3. Acute anaphylactic shock 4. Right heart failure 5. Fluid overload 6. Hypoalbuminemia |
|
|
What is the significance of ultrasonographic "sludge" within the gall bladder?
|
First, look at it from different angles to be sure it isn't slice thickness or grating lobe artifact.
In dogs- it means nothing In cats- it correlates with elevated liver enzymes |
|
|
What is the significance of ultrasonographic fluid surrounding the gall bladder?
|
May indicate ruptured gall bladder. Look for peritoneal effusion (may appear as fluid between liver and body wall), or other signs of bile peritonitis
|
|
|
What is the ultrasonographic significance of gall bladder calculi?
|
usually do not cause clinical signs
|
|
|
DDX for bile duct enlargement seen on ultrasound?
|
1. Pancreatitis
2. Calculus 3. Neoplasia (less common) 4. Inspissated bile 5. Ectasia d/t chronic inflammation 6. Other less common causes (duodenal mass, increased bile production, cyst, etc.) |
|
|
How do you differentiate the two common ultrasound views of the spleen?
|
Transverse view:
the head of the spleen curves way around and tucks up under the vertebrae near the aorta on the left side of the animal Saggital view: the shape of an upside-down triangle and it is normal to see the large splenic veins |
|
|
How do you differentiate a splenic mass from a pedunculated mass from another organ on ultrasound?
|
Splenic masses will have the "snake swallowing an egg" appearance of normal splenic tissue engulfing the abnormal tissue
|
|
|
DDX for ultrasonographic focal/multifocal cavitary lesions in the spleen?
|
1. Hemangiosarcoma (most common, worst px)
2. Hemangioma 3. Hematoma 4. Other neoplasms, cysts, abscesses, etc. (much less common) |
|
|
DDX for ultrasonographic hyperechoic solid lesions in the spleen?
|
1. Fat - bright white nodules located right next to splenic vessels
2. Fibrosis - secondary to prior injury 3. Splenic vascular mineralization - no clinical consequence other than considering possible cushings |
|
|
DDX for ultrasonographic hypoechoic, isoechoic, or target-type lesions in the spleen?
|
1. EMH - with or without anemia
2. Atypical lymphoid hyperplasia d/t antigenic stimulation 3. Neoplasia (round cell, metastatic, atypical hemangiosarc) – common to see peritoneal effusion d/t carcinomatosis 4. Other (i.e. granuloma) |
|
|
DDX for an ultrasonographic diffusely mottled texture to the spleen caused by small coalescing nodules?
|
1. Lymphoid hyperplasia (common in young animals)
2. EMH |
|
|
DDX for the spleen to be enlarged and black on ultrasound with no blood flow on Dopplar
|
1. Torsion
2. Infarction anechoic areas are necrotic d/t lack of blood flow |
