Radiographing Veterinary Emergencies Jane MacLellan

Common Veterinary Emergencies Gastric dilation-volvulus Hit by car Intestinal obstruction Blocked cat Respiratory distress Dystocia Toxicity Hemangiosarcoma I am just going to go over some common emergencies that will usually involve radiographs.

Radiographing Emergencies Stabilize first! Radiographs are not a treatment The most important thing to remember when radiographing an animal that presents as an emergency is to stabilize first. While taking a radiograph may be useful in the assessment of an injured or sick animal, it is probably not going to stop it from dying. So before you take the animal to radiology, make sure it is stable.

Gastric Dilation-Volvulus Normal stomach Parallel to ribs on Lateral view Pylorus on right Fundus on left GDV is something that usually happens to large breed dogs - think great danes. An important thing to recognize when radiographing a suspected GDV is what the stomach normally looks like. Basically it should lie parallel to the ribs on the lateral view, with the pylorus on the right and the fundus on the left.

Gastric Dilation-Volvulus Acute gastric dilation Stomach distended with gas, fluid, food. Pylorus and fundus in the normal position Gastric dilation-volvulus Stomach is rotated Pylorus is shifted dorsally and to the left = key to diagnosing GDV Lateral views are of most value Left lateral  pylorus filled with fluid Right lateral  pylorus filled with gas = Pylorus on left = GDV Compartmentalization  The other thing is to recognize the difference between straight gastric dilation and an actual GDV. With acute gastric dilation, the stomach becomes filled with gas, fluid, or food, but the pylorus and fundus stay in their normal position. With a GDV, the stomach becomes rotated, The pylorus is shifted dorsally and to the left - recognizing this on a radiograph is the key to diagnosing a GDV. If the patient is stable enough, you can take all three views - left and right laterals, as well as VD, but the lateral views are of the most value. If you shoot a left lateral and the pylorus is filled with fluid and then shoot a right lateral and the pylorus is filled with gas - this means that the pylorus is on the left and the dog most likely has a GDV. The other key thing to diagnosing a GDV is being able to recognize compartmentaliztion. Compartmentalization occurs when the stomach folds on itself and you see soft tissue bands in contrast to the gas filled lumen. This is what gives the characteristic pop-eye arm appearance.

Hit by Car Thorax Abdomen Lung contusions Pneumothorax Broken ribs Hemothorax Abdomen Loss of detail Hit by car is something that every one will see and the radiographs you need to take will vary quite a bit depending on the extent of injuries to the animal and what kind of signs it is showing. Obviously if the dog is holding its leg up and non-weight bearing, you will probably take rads that focus on that leg. However, all hit bit cars should have at least chest rads done because there can be serious injuries involving the chest that may not be visable to the naked eye. Things to look for on chest rads include lung contusions, pneumothorax, broken ribs, and blood or other fluid in the chest. You can also take abdominal radiographs and the main thing you will see will probably be loss of detail - this could point to internal bleeding or something like a ruptured bladder.

Hit by Car Musculoskeletal Fractures Luxations And then lastly, you will also want to look for musculoskeletal injuries such as fractures or luxations

HBC - Thorax The top picture is of a dog with a pneumothorax, as well as a lung contusion. When you see the heart lifted off the sternum like this, you should automatically think of a pneumothorax. You may also be able to see the lung lobes pulled away from the chest wall and increased opacity of the lobes because of collapse. Contusions show up as areas of increased opacity.

HBC - Abdomen Abdomen showing loss of detail, which after a trauma is most likely going to indicate blood or urine. If you can’t see the bladder on the radiograph, it is important to try to palpate the bladder to make sure it is intact, otherwise a ruptured bladder can easily be missed.

HBC - Musculoskeletal

Intestinal Obstruction Vomiting, lethargy, anorexia Dilation of bowel loops orad to obstruction Longer duration = greater distension Distal obstruction = greater amount of distended loops Partial obstructions are less obvious Frequent vomiting can remove gas/fluid Mineral/Metal are easily seen Non-mineralized/metalic objects difficult to see The GI track can become obstructed by a number of things - foreign bodies, masses, intussusceptions - and the obstruction can be complete or partial. Clinical signs are typically things like vomitting, lethargy, anorexia, or just not doing right. The most consistent sign you will see on radiogaphs is dilation of the bowl loops orad to the obstruction. The longer the obstruction has been there, the greater the distension will be, and the more distal the obstruction, the greater the number of distended loops. Partial obstructions will be less obvious and can be easily missed or frequent vomiting may remove the accumulated gas or fluid, also making the obstruction less obvious. Foreign bodies made of mineral or metal are usually easily seen but non-mineralized or metallic objects may be more difficult to see.

Intestinal Obstruction Linear FB Plicated appearance Short gas filled tubes Additional information to confirm obstruction Serial radiographs Contrast studies Barium swallow Ultrasound As we all know, in the case of a linear foreign body, you will want to look for pilcation of the bowel, and this basically looks like short gas filled tubes of bowel piled on top of each other. If you want additional information to confirm an obstruction before going to surgery, you can take serial radiographs over a period of 24 hours to see how things change and if they are moving through the guts. You could do barium swallow - if the obstruction is complete, it may take it a long time to reach the level of the obstruction, or the barium may even outline the object that is causing the obstruction, making it easier to visualize. And you could also do an ultrasound.

Bone Foreign Body

Linear Foreign Body

Contrast Study

Respiratory Distress Many differentials Radiographs can tell us A LOT Pneumonia Congestive heart failure Pneumothorax Pleural effusion Thoracic mass Radiographs can tell us A LOT Respiratory distress is one of those situations where radiographs may be your most important diagnostic tool because it can be caused by a long list of conditions. These include pneumonia, congestive heart failure, pneumothorax, pleural effusion, or a thoracic mass. Radiographs may not tell us everything, but they will certainly tell us a lot about the source of the problem.

Pneumothorax

Pneumonia

Congestive Heart Failure

Dystocia Radiographs are useful to detect: Position of fetus Size of fetus Number of fetuses left Whether fetus is still alive In the case of a dystocia, radiographs can tell us a few things - the position of the fetus, the size of the fetus and whether it will be able to fit through the birth canal, the number of fetuses left, and will give some clues as to whether the fetus is still alive or not.

Dystocia

Blocked Cat Radiographs shouldn’t be your first step Unblock the cat first! Once unblocked, may be helpful Stones Crystals If can’t unblock Location of the obstruction

Blocked Cat

Blocked Cat

Toxicity Loss of detail

Toxicity

Ruptured Hemangiosarcoma Loss of detail Abdominal mass Globoid heart - pericardial effusion Basketball heart

Ruptured Hemangiosarcoma