Ultrasound of the Liver

Ultrasound of the Liver
Wendy Blount, DVM Click on the blue arrow at bottom left or hit the “return” key to advance the show (mouse over to reveal) Free PowerPoint Templates

Patient Preparation Shave like a spay
Cranial to the costal arch May need to slide a few rib spaces cranially for intercostal Lateral to the right and left skin folds Caudal to the brim of the pelvis Place in dorsal or right lateral recumbency Lateral recumbency for compromised & deep chested patients May need L and R lateral recumbency if deep chested or a stomach full of air or food, or large abdominal mass Free PowerPoint Templates

Patient Preparation Standing Ultrasound
Giant breed dogs, profound abdominal enlargement Assessing effects of gravity on abnormalities Sedate only if safe and only if necessary Cardiac safe sedation dose chart (see Echo Section) Minimize interference of gas in gut No food for 12 hours (do not withhold water) Walk to encourage to defecate Sedate and give time if panting and aerophagic If all else fails, try again a few hours/days later Free PowerPoint Templates

Transition Adjustments
Depth - visualize at the bottom of the far field attachment of diaphragm to body wall dorsally caudal vena cava as it crosses the diaphragm Liver fills ¾ of the screen depth Linear array probe probably won’t work Frequency – 5-6 MHz large dogs, 7-8 MHz cats Gain and Contrast - adjust to your preference TGC - all sliders so all depths are seen in the best detail Often middle and bottom sliders to the right Free PowerPoint Templates

Image Views - Liver Sagittal Views Transverse Views
Free PowerPoint Templates

Image Views - Liver Sagittal Views (6 – 3 right, 1 middle, 2 left)
Right lateral cranial – right liver, diaphragm, maybe gall bladder Right lateral caudal – caudate lobe and right kidney Right medial – gall bladder, diaphragm Porta Hepatis (midline) – common bile duct, portal vein, caudal vena cava Left medial – aorta, L hepatic vein, L portal vein, stomach Left lateral – liver, head of spleen, maybe stomach Landmarks in blue Free PowerPoint Templates

Image Views - Liver Sagittal Views (6 – 3 right, 1 middle, 2 left)
Right lateral cranial – right liver, diaphragm, maybe gall bladder Right lateral caudal – caudate lobe and right kidney Right medial – gall bladder, diaphragm Porta Hepatis (midline) – common bile duct, portal vein, caudal vena cava Left medial – aorta, L hepatic vein, L portal vein, stomach Left lateral – liver, head of spleen, maybe stomach Landmarks in blue 3 4 1 5 6 2 Free PowerPoint Templates

Image Views - Liver Transverse Views (3-7) Cranial – liver, diaphragm
Middle – gall bladder, portal vein Caudal – caudal vena cava, hepatic vein, maybe gall bladder (Advanced – intercostal port hepatis) May need separate R and L views of each in the large dog Free PowerPoint Templates

Image Views - Liver Transverse Views (3-7) Cranial – liver, diaphragm
Middle – gall bladder, portal vein Caudal – caudal vena cava, hepatic vein, maybe gall bladder (Advanced – intercostal port hepatis) May need separate R and L views of each in the large dog 1 (4) 2 3 Free PowerPoint Templates

Scanning the Liver Sagittal Views Right Lateral Cranial Right Liver
Diaphragm Maybe Gall Bladder

Scanning the Liver Sagittal Views Right Medial Gall Bladder Diaphragm

Scanning the Liver Sagittal Views Right Medial Gall Bladder Diaphragm
Far field enhancement Mirror image

Scanning the Liver Sagittal Views Right Medial Gall Bladder Diaphragm

Scanning the Liver Sagittal Views Porta Hepatis Common Bile Duct
Portal Vein Caudal Vena Cava

Portal Vein Caudal Vena Cava stomach

stomach Porta Hepatis Common Bile Duct Portal Vein Caudal Vena Cava

Scanning the Liver Sagittal Views Right Lateral Caudal Caudate Lobe
Right Kidney

Scanning the Liver Sagittal Views Left Medial Aorta L Hepatic Vein
L Portal Vein Stomach

Scanning the Liver Sagittal Views Left Lateral Left Liver
Head of Spleen

Scanning the Liver Transverse Views Cranial Right Liver Left Liver
Diaphragm

Scanning the Liver Transverse Views Middle Gall Bladder Portal Vein

Scanning the Liver Transverse Views Caudal Caudal Vena Cava
Hepatic Vein Maybe Gall Bladder

Scan Technique Videos Oncura: Ultrasound of the Liver (no audio)
BCF Technology: right lateral recumbency Academy of Veterinary Imaging: dorsal recumbency Free PowerPoint Templates

Telemedicine Videos Hold the probe like an ice cream scoop
Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert (or you) will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (SonixOne) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Start to the right of the gall bladder See GB, vessels, stomach, then liver disappears Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Nice scan of the right liver. Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Nice scan of the left liver. Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Cranial aspect lost with inspiration Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) left aspect not quite reached at the end of the clip (too slow) Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Started at GB rather than at right extremity, need another clip for hepatic vein to left extremity Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Nice video of the left liver Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Gain too high; depth too shallow; need 2nd video for the left liver; start further to the right. Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Missed Cranial aspect of the liver. Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Nice scan of the right liver. Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Nice scan of the left liver. We’ll done! Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Transverse Video: cranial to caudal – entire liver Begin cranial to the gallbladder and end at the stomach Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Transverse Video: cranial to caudal – entire liver Begin cranial to the gallbladder and end at the stomach Beam shifts rom right to left as the scanner fans caudally. Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Transverse Video: cranial to caudal – entire liver Begin at the diaphragm and end at the stomach Gain set too high; Depth too shallow; need to split left and right. Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Transverse Video: cranial to caudal – entire liver Begin at the diaphragm and end at the stomach Nice Transverse Liver Scan Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Transverse Video: cranial to caudal – entire liver Begin at the diaphragm and end at the stomach Transverse Liver Scan – Right Side; missed caudal aspect Free PowerPoint Templates

Go fast enough to cover the entire liver Much faster than when scanning for lesions Expert will review frame by frame Sagittal Video: right to left – entire liver one 7-sec video clip for small dogs and cats (Oncura®) two 7-sec video clips for large dogs Two to three 3-sec video clips (most US machines) Transverse Video: cranial to caudal – entire liver Begin at the diaphragm and end at the stomach Nice Transverse Liver Scan – Left Side Free PowerPoint Templates

Telemedicine Videos Gall Bladder – 1 sagittal video Right to left
Elongate gall bladder as much as possible, to include neck and fundus Free PowerPoint Templates

Tips – Liver Ultrasound
Some prefer two long axis views of the gall bladder One fundus and one neck If you are having trouble locating the gall bladder Try the right intercostal approach Free PowerPoint Templates

Tips – Liver Ultrasound
Some prefer two long axis views of the gall bladder One fundus and one neck If you are having trouble locating the gall bladder Try the right intercostal approach GB Free PowerPoint Templates

Acknowledgments Stephanie Lisciandro, ACVIM (Internal Medicine)
Chapter 3: Focused or COAST3 – Liver and Gall Bladder Focused Ultrasound Techniques for the Small Animal Practitioner Editor Greg Lisciandro Bob Cole, ACVR Auburn University The Academy of Veterinary Imaging 2409 Avenue J, Suite C Arlington, TX (800)

Acknowledgments John Mattoon, Danelle Auld, Thomas Nyland
Chapter 4 – Abdominal Ultrasound Scanning Techniques Small Animal Diagnostic Ultrasound Editor, Nyland & Mattoon – 3rd edition 2014 Thomas Nyland, John Mattoon, Eric Herrgesell, Erik Wisner Chapter 6 – Liver Small Animal Diagnostic Ultrasound Editor, Nyland & Mattoon – 3rd edition 2014 Oklahoma State University Small Animal Cases

Acknowledgments University of Missouri-Columbia Liver-Spleen-Pancreas
John P. Graham, MVB, MSc, DVR, MRCVS Diplomate, ECVDI, Diplomate, ACVR Diagnostic Imaging in Dogs and Cats Nestle Purina – Clinical Handbook Series

Ultrasound of the Liver

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