Basic Abdominal Ultrasound

BASIC ABDOMINAL ULTRASOUND
ANATOMY AND RECOGNIZING NORMALS
 Amanda Breyette, LVT

 abreyette@uvsonline.com
 Kristina Wilson DVM, DACVR
 kwilson@uvsonline.com
CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

GOALS
 The goal of performing an abdominal ultrasound is to obtain

diagnostic quality images that can then be interpreted to
answer a clinical question.
 EX: Why is the patient vomiting or having diarrhea? Is there an
underlying cause of renal disease? Is there an intestinal
obstruction?

HISTORY
 Always communicate prior history. Does this patient have a

history of abdominal surgery- previous splenectomy? Hx of
pancreatitis? Elevated liver enzymes? Spayed/Neutered?

PREPPING FOR ULTRASOUND
 Fast your patient for 12 hours – no food, water ok
 Hold urination for 1-2 hours prior to exam
 Make sure ultrasound machine is labeled with correct patient – as the images are part of the medical record
 Shaving
 Far lateral - kidneys
 Intercostal spaces in deep chested dogs
 Choose appropriate probe size
 The higher the frequency the lower the depth of penetration
 Pick the highest frequency for your patient
 Linear vs curved transducer
 Indications
 Uniform gain through entire image
 Focus is on point of most interest
 Depth
TYPES OF TRANSDUCERS
Transducers
 Sector Transducers (real time B-
mode)
 Electronic
 Curvilinear array
 Phased array
 Linear array

START OF EXAM
 Utilize your v-troughs
 Start in dorsal recumbency
 Change positions – left and right lateral recumbency
 If your patient is comfortable they will stay still (or be more likely to stay still)
 Use sedation when needed !!!
 Torbugesic/Midazolam - 0.2-0.4mg/kg
 Torbugesic can cause panting and can cause ileus
 Acepromazine- splenomegaly
 Dexmedetomidine- slow HR, big cava
 Perform scan in same sequence every time
 Systematic approach –
 Organ to organ

KNOBOLOGY
 Depth
 Always set to be able to see the deepest margin of organ being imaged
 Focus
 Set within region of most interest
 Set where measurements are taken
 Overall gain
 Often left alone
 May need to change if poor contact (increase) or if abdominal fluid (decrease)
 TGC
 near and far fields
 Slides set to (b)right for deeper structures

KNOBOLOGY

IMAGING ISSUES
 Obese
 Falciform fat
 Depth
 Thin
 Nothing separating the organs
 Landmarks are distorted

IMAGING ISSUES

ORIENTATION
 Always get 2 views
 Sagittal plane view – marker faces cranial
 Cranial is to the left on the screen
 Transverse/ventral view – marker faces right.
 Right intercostal view – marker faces dorsal
 Left intercostal view – marker faces ventral
 Radiologist needs to know right from left!!!

 Sagittal Plane
ORIENTATION

 Transverse Plane
ORIENTATION

 Left intercostal view

 Right intercostal view

ORIENTATION
Sagittal View Transverse View

ALWAYS LABEL AND ARCHIVE!
REMEMBER TO CHANGE LABELS AS YOU

GO

CREATE A SYSTEMATIC APPROACH
 Liver/Gallbladder
 Stomach
 Pancreas-left limb (cat)
 Spleen
 Left Kidney
 Left Adrenal
 Bladder
 Urethra
 Prostate
 Colon
 Right Kidney
 Right Adrenal
 Pancreas- right limb (dog)
 Small intestine
 Lymph nodes
LIVER
 Located in the cranial abdomen
 Intercostal in deep chested dogs
 Always obtain the right dorsal intercostal view
 Move from right to left to ensure you image the entire liver
 Cranial is the diaphragm
 Far left is the spleen
 Caudal is the stomach
 Make sure depth is set to see all diaphragm to get dorsal liver
 Caudate lobe of liver, right dorsal intercostal

LIVER
 When evaluating liver size use your stomach as a landmark.
 In the sagittal view, the ventral portion of left liver should not extend beyond the gastric
body. The edge should also be tapered, not rounded.
 The right liver should not extend caudal to the right kidney.
 Usually mildly hypoechoic and coarse in comparison to the spleen and isoechoic
to the cortex of the kidney.
 Spleen-liver-renal cortex – SiLK
 Falciform fat is isoechoic and coarse echotexture, located between the right and left liver
lobes

LIVER
Normal Cat Normal Dog

LIVER
Right Dorsal Intercostal View Right Dorsal Intercostal View

LIVER
Sagittal view – small liver Right Dorsal Intercostal View

GALLBLADDER
 Located in the right cranial abdomen within the right liver lobe
 Varies in size
 Becomes distended in anorexic or fasted patients
 Bilobed in ~25% of cats – rarely in dogs

GALLBLADDER
 Wall thin and smooth
 1mm in cats
 2mm in dogs
 Sludge
 Reposition to confirm sludge vs. mass
 Not common in cats
 Almost always in dogs
 Common Bile Duct (CBD) can be seen more easily in cats

GALLBLADDER
Bilobed Common Bile Duct

GALLBLADDER
Sludge

GALLBLADDER
Standing Dorsal Recumbency

STOMACH
 Located in mid cranial abdomen
 Fundus, body, pyloric antrum – left to right
 Gas distraction
 Rugal folds and peristalsis
 Measures 2-5mm in the dog and 1.7-3.6mm in the cat
 Try to identify the pyloric sphincter

STOMACH
Body Rugal Folds

STOMACH
Gas distraction Pylorus

SPLEEN
 Head, body and tail
 Head and body located in the mid/left cranial abdomen
 Tail can cross midline
 “tongue” shaped
 Margins are usually tapered
 Hyperechoic with a fine echotexture in comparison of the
liver/renal cortex

SPLEEN
 In large or deep chested dogs the head of the spleen can be more
easily seen when the patient is in right lateral recumbency and
imaged left dorsal intercostal.
 The spleen can be folded on itself making it appear larger
 Individual variations in size
 1cm width at hilus in cats
 < 3.5cm in most dogs

SPLEEN
Cat Spleen Dog Spleen

SPLEEN
Dog Spleen Cat Spleen

KIDNEYS
 Should be symmetrical in size and shape
 Oval (particularly in cats) or bean shaped
 In cats the normal length is 3.0-4.5cm
 In dogs the length varies due to size/breed
 5cm in 50# dog
 6cm in 60# dog
 7cm in 70# dog
 No kidney should be above 11cm no matter how big the dog is
 Cortex is usually hypoechoic or isoechoic to the liver and hypoechoic to the spleen
 Can be hyperechoic in overweight cats
 Medulla is hypoechoic
 Pelvis is not usually seen
 Can be slightly distended in animals who are on fluids

LEFT KIDNEY
 Located in the left cranial-mid abdomen

 Can be difficult to visualize when patients have a full colon

LEFT KIDNEY
Parasagittal Sagittal

LEFT KIDNEY
Transverse Transverse

ADRENAL GLANDS
 Hypoechoic to the surrounding fat
 When using a high frequency transducer you can see the cortex and medulla
 Can be mistaken for vessels – use your doppler
 In cats the glands are short, ovoid or cylindrical
 10-11mm long and ~4mm in width
 In dogs the glands are elongated and have a more classic “peanut” shape
 10-50mm long and up to 8mm in width
 Measure both poles

LEFT ADRENAL
 Located medial to the left kidney
 Use your vasculature as landmarks
 Lateral to the aorta
 Cranial to the left renal artery
 Dorsal/ventral to the left phreniocoabdominal artery and vein
 Vein is easier to see and splits the gland into two poles
 Fan ventral/dorsal until the gland is located
 Asymmetry in poles could indicate a tumor

LEFT ADRENAL
Small Dog Large Dog

LEFT ADRENAL
Cat Cat

LEFT ADRENAL
Dog Cat

URINARY BLADDER
 Located on midline in the caudal abdomen
 Best to image when the bladder it is moderately distended
 Can place a u-cath and fill the bladder with 0.9% NaCL
 Wait for it to fill naturally
 Urine should be anechoic
 Wall thickness decreases and the volume increases
 Larger bladder = decreased wall thickness
 In cats normal wall thickness is up to 1.7mm
 In dogs it varies depending on side of the bladder

URINARY BLADDER
Sagittal Cat Transverse Cat

URINARY BLADDER
Sagittal Dog Transverse Dog

COLON
 Located in the caudal, left, cranial and right abdomen.
 Left = descending
 Right = ascending
 Cranial = transverse
 Often filled with gas and/or feces
 Empty colon
 Wall is hyperechoic
 Transverse view almost looks like a tiny stomach
 Has a thinner wall than the small bowel
 Measures 2-3mm in the dog and 1.4-2.5mm in the cat

COLON
Sagittal Transverse

COLON
Empty Empty

PROSTATE
 Neutered dogs
 Hypoechoic and ovoid
 <2cm in length
 Intact dogs
 Large, hyperechoic, uniform echogenicity, bilobed
 Size varies with age
 Similar echogenicity to spleen

PROSTATE
Neutered Dog Intact Dog

RIGHT KIDNEY
 Located in the right cranial/dorsal abdomen

 More difficult to image
 In large or deep chested dogs it can be more easily seen when
the patient is in left lateral recumbency and imaged intercostal

RIGHT KIDNEY
Sagittal Dog Transverse Dog

RIGHT KIDNEY
Sagittal Large Dog Sagittal Cat

RIGHT ADRENAL GLAND
 Located in the right cranial quadrant close to the caudal vena

cava
 Fan ventral/dorsal through the CVC until the gland is visualized
 Image intercostal
 Use transverse approach

RIGHT ADRENAL GLAND
Dog Cat

SMALL INTESTINE
 5 different layers
 Lumen, mucosa, submucosa, muscularis, subserosa/serosa
 High frequency probe
 Mucosa is the thickest layer
 Measure form the outer aspect of the serosa and to the inner border of the mucosa
 Descending duodenum
 Located in the far right cranial/mid abdomen
 Thicker than the remainder of small intestine
 Measures 3-6mm in dogs and 2-2.5mm in cats
 Duodenal papilla

SMALL INTESTINE
 Jejunum
 Located in the mid abdomen
 Measures 2-5mm in dogs and 2-3 mm in cats
 Ileocecocolic Junction
 Located in the right cranial abdomen
 More easily visible in cats
 Often difficult to identify due to gas collection in this area
 Ileum is more easily identifiable due to its prominent and bright submucosal layer
 Measures 2-4mm in dogs and 2.5-3.2mm in cats
 Often thick muscular layer at the terminal part of the ileum

SMALL INTESTINE
Wall Layering Wall Layering

SMALL INTESTINE
Duodenum Cat Duodenum Dog

SMALL INTESTINE
Duodenal Papilla

SMALL INTESTINE
Jejunum Jejunum

SMALL INTESTINE
Jejunum Jejunum

SMALL INTESTINE
Ileocecocolic Junction Ileocecocolic Junction

LYMPH NODES
 Use your vessels as landmarks
 Numerous lymph nodes within the abdomen and each have a different draining area
 Mesenteric/Jejunal
 Located along the cranial mesenteric artery and vein
 Uniformly echogenic, isoechoic or slightly hypoechoc to the surrounding fat.
 Thin hyperechoic capsule
 Usually <4cm in cats and <5cm in dogs
 Increased in puppies
 Can be up to 1cm
 -Medial iliac
 Located at the caudal aortic trifurcation
 More easily identifiable by using a lateral flank approach
 Measure up to 7-8mm

LYMPH NODES
Mesenteric/Jejunal Right Iliac

PANCREAS
 Has 3 portions
 Right, left and body
 Right lobe dorsomedial to the descending duodenum and ventral to the right kidney
 The body is caudal to the pyloric region
 The left lobe is dorsocaudal to the gastric antrum and crosses midline
 Can be seen between the stomach and transverse colon
 If you can see the stomach, spleen and left kidney in the same picture chances are the left
pancreas is in there too
 Homogeneous and is isoechoic or slightly hyperechoic

PANCREAS
Dog Cat

PANCREAS
Dog Cat

ARTIFACTS
 Side-lobe
 Grating-lobe
 Mirror-image
 Acoustic enhancement
 Acoustic shadow

SIDE LOBE ARTIFACT
 Intense echoes from lateral lobes are mismapped as being within main
lobe
 Occurs with high reflective interfaces lateral to anechoic object in main beam
 Correct by lower gain, lower frequency, change orientation or deeper

focus

SIDE LOBE ARTIFACT

ARTIFACTS
Acoustic enhancement Mirror image

REFERENCES

MISCELLANEOUS

MISCELLANEOUS

“ QUESTIONS
QUESTIONS?
”

Basic Abdominal Ultrasound

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Basic Abdominal Ultrasound

Uploaded by

Copyright:

Available Formats

BASIC ABDOMINAL ULTRASOUND

ANATOMY AND RECOGNIZING NORMALS

 Amanda Breyette, LVT

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

 The goal of performing an abdominal ultrasound is to obtain

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

 Always communicate prior history. Does this patient have a

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Sagittal View Transverse View

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

REMEMBER TO CHANGE LABELS AS YOU

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Normal Cat Normal Dog

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Right Dorsal Intercostal View Right Dorsal Intercostal View

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Sagittal view – small liver Right Dorsal Intercostal View

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Bilobed Common Bile Duct

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Standing Dorsal Recumbency

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Body Rugal Folds

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Gas distraction Pylorus

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Cat Spleen Dog Spleen

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Dog Spleen Cat Spleen

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

 Located in the left cranial-mid abdomen

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Small Dog Large Dog

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM

Sagittal Cat Transverse Cat

CE FALL 2017 | BASIC ABDOMINAL ULTRASOUND 11/14/2017 WWW.UVSONLINE.COM