Diagnostic Imaging- Ultrasound Spleen, Liver, and Pancreas

spleen

ID organ

lateral and VD

large breed canine spleens can be seen on both _____ and _____ images

abnormal- enlarged

is this a normal or abnormal spleen?

-left lateral

-lateral

in feline patients, the spleen will normally only be seen along the ________ body wall and typically not seen on _______ views

-splenomegaly

-splenic mass

-traumatic injury

-neoplasia

-anemia

-abdominal pain

what are spleen indications for scanning?

7.5-12

what MHz probe do you use for an ultrasound of the spleen for small animals?

transrectal- 5

transabdominal- 3-5

for ultrasound of the spleen for the horse, what MHz do you use transrectally? transabdominally?

cranial

the fundus of the stomach is located _______ to the spleen

caudal and deep

left kidney is _____ and ______ to spleen

caudal and medial

the left lobe of the pancreas is located ______ and ______ to the spleen

splenic

the left lobe of the pancreas is adjacent to the ______ vein

German Shepherd dogs

what breed of dog will have a larger spleen?

extends beyond the costal arch some crossing over to the right cranial to mid abdomen, some extending to the urinary bladder

where does the spleen extend in large dogs?

left cranial

cat spleens are usually in the ________ abdomen

<1 cm

normal spleen thickness for a cat?

-gastrosplenic

-left cranial

the head of the spleen is fixed by the ________ ligament and located in the ________ abdomen

body and tail

the _______ and ______ of the spleen are more mobile

-right

-left lateral

the body and tail of the spleen may cross over to the

_______ side or along the ____ ____ body wall

...

this is the spleen, just know what it looks like!!

well-defined

in normal US of the spleen, the capsule is usually ________

-homogenous

-less coarse

the spleen has ______ parenchyma with uniform finely stippled pattern less/more coarse than the liver

liver and renal cortex

the spleen is more hypoechoic than what two structures in the dog?

isoechoic or hypoechoic

in cats, the spleen can be _________ or ________ to the renal cortex (echogenicity-wise)

smooth

it is important to look for _______ borders of the spleen to detect masses

left- liver

right- spleen, b/c hyperechoic

which is the liver and which is the spleen based off of echogenicity?

splenic

the _______ artery is not often detected without color doppler

-blue

-larger

-red

when using color doppler in ultrasound, veins appear _______ in color and are larger OR smaller than corresponding arteries depicted in ______ color?

color dopler

what type of tool is being used in this ultrasound to see the different vessels?

shadowing, hyperechoic

surrounding fat around the spleen causes _______ and appears what echogenicity?

yes, from surrounding fat

is this shadowing near the spleen normal?

shadowing underneath the mass

if there is a hyperechoic mass in the spleen, what artifact will occur due to it?

shadowing due to the splenic mass

what are the arrows indicating? (there is a mass in this spleen)

1. compare echogenicity of liver and renal cortex

2. classify lesion as focal or diffuse

3. focal lesions easier to recognize

4. uniform pattern/echotexture

what four things should you evaluate when ultrasounding the spleen?

focal

are these ultrasound images of the spleen focal or diffuse?

diffuse

are these ultrasound images of the spleen focal or diffuse?

-clinical signs/history

-blood work indications

-hepatomegaly/mass

-tumor staging

-suspected diaphragmatic hernia

-liver biopsy/following response to therapy

what are some liver indications for ultrasound?

5-7.5 MHz

what frequency should you ultrasound the liver at?

-resolution

-penetration

high frequency = better ________

lower frequency = better ________

yes, to see deeper parts of the liver can switch to lower frequency or vice versa

is it okay to switch between different frequency probes when evaluating the liver?

-body conformation

-liver size

-GI gas

visualization of the liver is dependent on what 3 things?

subcostal

in small breed dogs with normal liver size, typically can be scanned from a ________ approach

intercostal

in large breed dogs with a small liver or ingesta in the stomach requires an ______ approach

hypoechoic

the liver is what echogenecity compared to the spleen?

uniform, coarse echogenic pattern and smooth sharp border

the normal liver appears how in regards to the echogenic pattern and border?

-obesity

-type of transducer

what two factors affect echogenicity of the liver?

at the gastric fundus (or the spleen in some dogs)

where is the left caudal border of the liver located?

at the liver/diaphragm interface

where is the cranial border of the liver located?

right kidney surrounded by caudate process of caudate lobe of the liver

where is the right caudal border of the liver located?

cranial border of liver

what part of the liver is this showing?

left caudal border of the liver

what part of the liver is this showing?

right caudal border of the liver

what part of the liver is this showing?

rounded and not sharp

the borders of the liver should be what shape?

intercostal

where are the normal borders located of the liver in large breed dogs?

beyond the costal arch

where do normal borders of the liver in small breed dogs extend to?

parallel

the stomach axis is ______ to the ribs

right- there is a mass on the ventral side

which of these US images of the liver is abnormal?

diaphragm

what is the red arrow pointing to in the left image?

right cranial dorsolateral aspect

the dorsal vessels of the liver are best viewed from what aspect of the abdomen?

dorsal and left

the aorta is located where?

no!

is the aorta compressible or pulsatile?

ventral and right

the caudal vena cava is located where in respect to the aorta?

yes

is the caudal vena cava compressible?

more ventral and left

the portal vein is located where in comparison to the caudal vena cava?

dorsal

the portal vein is ________ to the common bile duct

portal veins

the _____ veins have the most echogenic walls

at the diaphragm

hepatic veins join the caudal vena cava where?

anechoic

the hepatic veins are what echogenicity?

hepatic veins

do portal veins or hepatic veins have less delineated walls?

hyperechoic

portal veins have a more _______ border than the hepatic veins

left- hepatic vein

right- portal vein

which US shows the portal vein and which is hepatic vein?

hepatic

______ arteries are not detected on 2D images and only found with color flow Doppler

arteries

with color doppler, _______ are the small vascular structures depicted with red color

-cranially

-ribs

with a small liver on rads, the stomach axis will shift _______ and is not parallel with the ____

caudally

with hepatomegaly rads, the stomach axis shifts ______ and is not parallel with the ribs

right image

which US image shows the normal liver?

focal mass

what focal change does this show in the liver?

nodular lesions

what is the red arrow indicating from this ultrasound of the liver?

abnormal

is this a normal or abnormal liver US?

echogenicity- anechoic

shape- tear drop

how does the gallbladder appear on ultrasound? (echogenicity and shape)

the right side of the liver

where is the gallbladder located in respect to the liver?

1

the wall of the gallbladder is usually less than ____ mm in cats and dogs

anechoic

normal bile is what echogenicity?

biliary sludge or concretions

what is the echogenic material in the gallbladder?

gallbladder

if this US image was taken on the right side of the liver, what structure would this be?

distal enhancement

what artifact is the red circle indicating underneath the gallbladder?

-distal acoustic enhancement

-refraction

what are the two artifacts associated with the gallbladder?

increases echogenicity in liver parenchyma deep to gallbladder

what does distal acoustic enhancement do?

bending artifact at edges of gallbladder, seen at curved surfaces

what is refraction artifact?

star- distal enhancement

arrow- refraction

does the star or arrows show distal enhancement or refraction?

common

the cystic duct joins the hepatic bile duct to become the _______ bile duct

common bile duct

what duct enters the duodenal wall?

portal vein

the common bile duct runs parallel to what vein?

intrahepatic biliary ducts

which biliary ducts are not normally visualized?

1

the wall of the common bile duct should not be greater than ____ mm

no

enlarged intrahepatic biliary ducts have _____ blood flow

color Doppler

what tool can be used to help distinguish an enlarged intrahepatic biliary duct from a blood vessel

intrahepatic biliary duct

what duct is being shown with the red outline?

meals

gallbladder size can vary after what event?

yes

in cats, can the gallbladder neck be compressed with the US probe?

cats

in what species can the gallbladder have various shapes and may be duplicated?