Felis ISSN 2398-2950

Ultrasonography: non-cardiac thoracic

Contributor(s): Avi Avner, Andrew Holloway

Introduction

Uses

  • Investigation of:
    • Thoracic wall lesions.
    • Peripherally located pulmonary lesions
    • Pulmonary consolidation/atelectasis.
    • Pulmonary arteries: pulmonary hypertension.
    • Mediastinal masses   Mediastinal disease  .
    • Pleural masses   Lung: pulmonary neoplasia  .
    • Pleural effusion   Pleural effusion  .
    • Diaphragm.
    • Interventional procedures (guidance or localization)

Advantages

  • Low cost.
  • Non-invasive.
  • Short time requirement if experienced.
  • Examination possible without sedation.
  • No known biological risk
  • Allows ultrasound guided: Fine needle aspirate (FNA   Fine needle aspirate: ultrasound-guided  ) or large-bore biopsy procedures (tru-cut biopsy)   Biopsy: ultrasound-guided  .
  • Allows evaluation of other organs for related problems, eg abdominal organs in diaphragmatic hernia   Diaphragm: hernia  or if neoplastic disease suspected.

Disadvantages

  • Investigation is dependent on operator skill and suitability of ultrasonographic equipment.
  • Examination is poorly reproducible and remote interpretation difficult.
  • May require patients coat to be clipped.
  • Normal sonographic appearance does not exclude disease.
  • Ultrasound investigation doesnt replace thoracic radiography, it complements it.
  • Abnormal sonographic appearance doesnt always indicate significant disease.
  • Similar sonographic appearance with different diseases.

Potential problems

  • Poor transducer-skin contact (inadequate clipping or insufficient coupling gel).
  • Inadequate patient restraint.
  • Operator inexperience.
  • Lesion obscured by aerated lung.
  • Acoustic shadowing artifacts produced by the ribs.
  • Inadequate equipment (transducers with large contact area).


Alternatives

  • Plain or contrast radiography   Radiography: thorax  will complement the ultrasonographic investigation.
  • CT   Computed tomography (CT)  is the imaging modality of choice for evaluating the thoracic structures including the lungs because of its superior contrast resolution and tomographic nature.
  • MRI has proven extremely valuable to evaluate abnormalities of the thoracic wall, diaphragm, and mediastinum. MRI can also be valuable for both anatomic and functional assessment of the great vessels and pulmonary arteries. Its clinical value to assess lung disease is currently limited. 

Equipment

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Patient preparation

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Normal anatomy

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Abnormalities

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Further Reading

Publications

Refereed papers
  • Recent references fromPubMed.
  • Reichle J K & Wisner E R (2000)Non-cardiac thoracic ultrasound in 75 feline and canine patients. Vet Radiol Ultrasound41(2), 154-162PubMed.
  • Tidwell A S (1998)Ultrasonography of the thorax (excluding the heart). Vet Clin North Am Small Anim Pract28(4), 993-1015PubMed.
  • Stowater J L & Lamb C R (1989)Ultrasonography of noncardiac thoracic diseases in small animals. JAVMA195(4), 514-520.


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