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 64 NOVEMBER/DECEMBER 2018 a dyspneic patient, therapeutic thoracocentesis is indicated. When normally inflated, the pulmonary parenchyma cannot be visualized using ultrasound. Thoracic (pleural and pericardial) effusions have identical ultrasound characteristics to peritoneal effusions. In the presence of sufficient thoracic effusion, pulmonary atelectasis occurs and the collapsed lung parenchyma may be visualized as well-defined, triangular echogenic structures floating within the effusion. Thus, thoracic effusion can improve the acoustic window to the pulmonary parenchyma as well as the heart. Considerations for thoracic effusions are listed in BOX 1 . Assessment of the Pulmonary Parenchyma Using Vet BLUE The primary goal of the veterinary bedside lung ultrasound exam (Vet BLUE) is to identify diseased pulmonary parenchyma. Diseased lung tissue often involves additional fluid or cells within the interstitial and/or alveolar spaces (i.e., wet lung), resulting in increased penetration of the ultrasound beam beyond the visceral pleural surface. Vet BLUE exploits this phenomenon by utilizing the ultrasound findings associated with wet lung as an indicator for pulmonary disease. This examination is useful when critical patient status prevents thoracic radiography. Differential diagnostic considerations for wet lung must take into account the distribution of affected lung tissue as well as the specific patient context. For example, identifying wet lung caudodorsally in an electrocuted patient or a patient with a history of FIGURE 8. Right lateral radiograph showing the probe positions during the Vet BLUE examination. The arrows indicate the starting point (cdll) and the ending point (crll). cdll, caudal lung lobe, crll, cranial lung lobe; mdll, middle lung lobe; phll, perihilar lung lobe. FIGURE 7. Dorsal plane ultrasound image of the pulmonary–pleural interface (double-headed arrow), indicating a positive glide sign: the rhythmic to-and-fro motion of the pulmonary pleura along the costal pleural surface during normal respiration. The ribs (R) create a curved hyperechoic line over an anechoic area; their associated shadows originate from the superficial aspect of the rib and extend through the pulmonary–pleural interface. FIGURE 9. (A) Dorsal plane image from a dog with wet lung documenting the presence of B-lines (orange arrows). This finding is associated with peripheral or diffuse pulmonary pathology. (B) Right lateral radiograph from the same dog documenting the diffuse unstructured interstitial pulmonary changes. The final diagnosis was diffuse vasculitis with interstitial edema on histologic evaluation. A B

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