Today's Veterinary Practice

NOV-DEC 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 62 NOVEMBER/DECEMBER 2018 kidney is located within the renal fossa of the caudate process of the caudate lobe of the liver in dogs; in cats, it is typically separated from the caudate lobe of the liver by retroperitoneal fat. Relative to the left kidney, the right kidney is generally in a more cranial and lateral position. To obtain the HR window, place the probe caudal to the right 13th rib, ventral to the lumbar hypaxial musculature, and fan dorsomedially to search for the interface of the right kidney with the liver. The relatively cranial position of the right kidney generally makes it necessary to angle the probe cranially before fanning. In large-breed or deep-chested dogs, a dorsolateral, 11th or 12th intercostal space approach may be necessary to visualize the right kidney. In the HR window, anechoic material between the hepatic parenchyma and the the kidney represents a retroperitoneal or peritoneal effusion ( FIGURE 5 ). TFAST TECHNIQUE The TFAST examination involves assessment of both hemithoraces for pleural space disease (presence of gas or effusion) and pericardial effusion. With training and/or experience, the examination can include focused echocardiography as well as assessment of the peripheral pulmonary parenchyma for peripheral or diffuse lung diseases. Once the patient is stabilized, the lungs should be completely evaluated by obtaining 3-view thoracic radiographs. In echocardiography, the machine logo marker is positioned on the right of the screen so that cranial on the dog or cat is to the viewer's right. This is opposite from abdominal ultrasonography. In the following description, the probe and the machine logo positions are the same as those used for an abdominal scan. Assessing for Pleural Space Disease A primary goal of the TFAST examination is to assess for the presence of gas within the left and/or right pleural spaces. The probe position for identifying gas within the pleural space has been described as the chest tube site: dorsolateral along the thoracic wall, with the transducer notch pointing cranially (cranial is on the left side of the screen), within the 7th to 9th intercostal spaces, bilaterally ( FIGURE 6 ). 4 From this position, the interface between the pulmonary (visceral) pleural surface with the costal (parietal) pleural surface is identified. In a normal individual, the rhythmic to-and-fro motion at this interface constitutes a glide sign ( FIGURE 7 ). The absence of a glide sign is indicative of gas within the pleural space. If pneumothorax is identified in FIGURE 5. Hepatorenal window showing the right kidney (RK), liver (L), and scant interposed peritoneal effusion (*). FIGURE 6. Schematic diagram of a TFAST examination performed in right lateral recumbency. The DH window is not part of a routine TFAST examination; however, by angling the transducer cranially and increasing the depth on the image, the sonographer can have another window to evaluate the pleural space, accessory lung lobe, and cardiac structures. CTS, chest tube site; DH, diaphragmatic-hepatic window; PCS, pericardial site.

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