Page 145 - Basic Monitoring in Canine and Feline Emergency Patients

TFAST below). Lack of the glide sign can increase young puppies and kittens a small amount of free
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suspicion for the presence of a pneumothorax. The fluid in this view has been described as a normal
VetBooks.ir DH view can also be used to assess for US B-lines finding but other fluid accumulations are consid-
ered pathologic.
(previously called lung rockets or comet tails; see
Obtain the CC view the following way:
TFAST section).
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1. Place the curvilinear US probe longitudinally
4. Finally, for an advanced DH view assessment, (US indicator/notch pointed cranially toward the
the probe should be fanned dorsocaudally away patient’s head) just cranial to where the flank meets
from the gall bladder toward the great vessels. the body wall.
Here an advanced operator may be able to estimate 2. Direct the probe toward the gravity-dependent
intravascular fluid volumes. This component to the region – a pocket made up of the urinary blad-
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AFAST examination is beyond the scope of this der, colon, and the body wall. A classic finding
chapter (see Further Reading section). with free fluid is an anechoic triangle between
the urinary bladder and abdominal body wall.
Splenorenal view The CC view has multiple chances for artifacts
that should be kept in mind. Fluid within the
The SR view surveys for free fluid around the
spleen, left kidney, and retroperitoneal and periton- urinary bladder will create an acoustic enhance-
eal spaces. Classically, free fluid found in this view ment artifact, causing soft tissues visible deep to
is between the spleen and colon; other structures the urinary bladder to appear more hyperechoic
should be evaluated as detailed below. than normal. Additionally, a gas-filled colon may
Obtain the SR view in the following way: create reverberation and shadowing artifacts that
may obscure tissues deep to the colon. The opera-
1. With the patient in right lateral recumbency, tor can sometimes alleviate some of the artifact
place the curvilinear US probe longitudinally (US by manipulating the colon out of view by gentle
marker placed cranially toward the patient’s head), alterations of pressure and slight position chang-
parallel to the spine, just caudal to the last rib (at ing of the US probe.
the costal arch), and fan the probe cranially under
the rib. In order to distinguish loops of fluid-filled Hepatorenal view
bowel/colon or a fluid-filled gravid uterus from
free fluid, evaluate the structure in both longitudi- The HR view surveys for free fluid along the most
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nal and transverse planes. To image in transverse, gravity-dependent area of the AFAST examina-
slowly rotate the US probe 90 degrees so that the tion. Despite being named the hepato-renal view, it
notch is facing the patient’s right-hand side (i.e. is not normal to visualize the liver or the right
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moving to the AFAST operator’s left). kidney during this component of the AFAST
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2. Return the probe to the start position, direct assessment. The liver is only seen in this view when
it caudally, and then fan from side to side. While there is significant hepatomegaly. The right kidney
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fanning back and forth, the AFAST operator can is not actively imaged unless trauma is suspected to
evaluate the retroperitoneal space. Free fluid within the right kidney. In situations where it is important
the retroperitoneal space should raise concern for to view the right kidney, the patient is moved into
differentials such as ongoing hemorrhage, sterile left lateral or sternal recumbency to facilitate
and nonsterile effusions, and uroabdomen. imaging.
Obtain the HR view the following way:
1. Place the probe longitudinally (the notch/indica-
Cystocolic view
tor facing cranially toward the patient’s head) just
The CC view surveys for free fluid around the uri- below/right lateral to the umbilicus with the animal
nary bladder and body wall. Despite the colic com- in right lateral recumbency. Often loops of bowel
ponent of the name, the colon wall is the only thing and occasionally the spleen are seen with this view.
that can be imaged as the gas present in the colon To help differentiate free fluid from loops of bowel,
will create artifact obscuring the remainder of the image the structures in both longitudinal and trans-
colon. Therefore, most of the imaging for the CC verse US planes. To image in transverse, rotate the
view is focused around the urinary bladder. In very US probe slowly 90° so that the notch is facing the

Applications of Serial Focal Ultrasound Techniques in the Hospitalized Small Animal Patient 137