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 66 NOVEMBER/DECEMBER 2018 todaysveterinarypractice.com techniques are beyond the scope of this article and have been published elsewhere. 9–11 Assessment of the left atrial chamber dimension in relation to the aorta can aid in the diagnosis of congestive heart failure. Normal left atrium- to-aorta ratios in the dog and cat are 1.3 and 1.5, respectively. 9,10 A right-sided, parasternal, short axis view at the level of the heart base is most commonly used for assessing left atrial size. This view is generated by placing the probe along the right ventral thoracic body wall at the point of the elbow, with the marker oriented towards the patient's tail. Obliquity of this projection can distort the appearance of the left atrium, and care must be taken to ensure true orthogonal beam orientation to the long axis of the heart. Focused echocardiography findings must always be considered in the context of additional physical examination and diagnostic findings. Radiographs are ultimately required to diagnose congestive heart failure. CONCLUSION The AFAST and TFAST examinations are powerful diagnostic tools used in a variety of patient settings. Whenever ultrasound is available, these examinations can provide the clinician with immediate, actionable information at minimal risk to the patient (e.g., minimal time; minimal restraint; no radiation involved). Ultrasound is an advanced imaging modality, and a complete examination requires advanced training and thorough cross-sectional anatomic knowledge. In contrast, AFAST and TFAST require limited anatomic study, and nonradiologist veterinarians can achieve proficiency with training. References 1. Lisciandro GR. Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals. J Vet Emerg Crit Care 2011;21(2):104-122. doi:10.1111/j.1476-4431.2011.00626.x. 2. Boysen SR, Lisciandro GR. The use of ultrasound for dogs and cats in the emergency room. Vet Clin N Am Small Anim Pract 2013;43(4):773- 797. doi:10.1016/j.cvsm.2013.03.011. 3. Boysen SR, Rozanski EA, Tidwell AS, et al. Evaluation of a focused assessment with sonography for trauma protocol to detect free abdominal fluid in dogs involved in motor vehicle accidents. J AVMA 2004;225(8):1198-1204. doi:10.2460/javma.2004.225.1198. 4. Lisciandro GR, Lagutchik MS, Mann KA, et al. Evaluation of a thoracic focused assessment with sonography for trauma (TFAST) protocol to detect pneumothorax and concurrent thoracic injury in 145 traumatized dogs. J Vet Emerg Crit Care 2008;18(3):258-269. doi:10.1111/j.1476- 4431.2008.00312.x. 5. McMurray J, Boysen S, Chalhoub S. Focused assessment with sonography in nontraumatized dogs and cats in the emergency and critical care setting. J Vet Emerg Crit Care 2016;26(1):64-73. doi:10.1111/ vec.12376. 6. Mattoon JS, Nyland TG. Ultrasound-guided aspiration and biopsy procedures. In: Small Animal Diagnostic Ultrasound. Elsevier Health Sciences; 2014; 50-77. 7. Ianniello S, Di Giacomo V, Sessa B, Miele V. First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med 2014;119(9):674-680. doi:10.1007/s11547-014-0384-1. 8. Choi J, Kim A, Keh S, et al. Comparison between ultrasonographic and clinical findings in 43 dogs with gallbladder mucoceles. Vet Radiol Ultrasound 2013;55(2):202-207. doi:10.1111/vru.12120. 9. Rishniw M, Erb HN. Evaluation of four 2-dimensional echocardiographic methods of assessing left atrial size in dogs. J Vet Intern Med 2000;14(4):429-435. doi:10.1111/j.1939-1676.2000.tb02252.x. 10. Abbott JA, MacL ean HA. Two-dimensional echocardiographic assessment of the feline left atrium. J Vet Intern Med 2006;20(1):111-119. 11. Boon JA. Veterinary Echocardiography. 2 nd ed. Ames, IA: Wiley Blackwell; 2011. FIGURE 10. Thoracic ultrasound image obtained at the pericardial site showing a large amount of anechoic pericardial effusion. Ht, heart; PE, pericardial effusion. Philip (PJ) Hamel Philip (PJ) Hamel, DVM, MPH, is a diagnostic imaging resident at the University of Florida College of Veterinary Medicine. His professional interests include diagnostic imaging of domestic and nondomestic animal species, as well as image-guided interventions. He is originally from Massachusetts, where he attended veterinary school at Tufts University. Clifford R. Berry Clifford R. Berry, DVM, DACVR, is a professor of diagnostic imaging at University of Florida College of Veterinary Medicine. His research interests include cross- sectional imaging of the thorax, nuclear medicine, and biomedical applications of imaging. He received his DVM from University of Florida and completed a radiology residency at University of California–Davis.

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