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Basics of thoracic ultrasonography

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Abstract

Non-cardiac thoracic ultrasonography is increasingly used in veterinary medicine. Despite the fact that ultrasound waves are not able to penetrate air-containing lung, there are many applications of non-cardiac thoracic ultrasonography. This chapter covers General thoracic ultrasonography; Echocardiography; Endoscopic thoracic ultrasonography.Detailed examples of possible views are included, along with examples of equations.

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Figures

Image of 2.1
2.1 Dorsal image of the thorax of a normal adult Border Collie, using an 8 MHz microcurved transducer. The chest wall with subcutaneous fat and intercostal musculature is mainly hypoechoic with linear striations. The ribs (*) are seen in cross section and create a strong distal acoustic shadow. The lung surface presents as a bright hyperechoic line.
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2.2 Transverse image of the dorsal eighth intercostal space of a normal adult Border Collie, using a 12 MHz linear transducer. Compared with Figure 2.1 , the layers of the body wall (thin arrow) in the near field are shown with better resolution due to the high frequency and linear nature of the transducer. The lung surface is visible as a bright, continuous line (arrowheads). Distal to the lung surface, the attenuation of the sound waves results in shadowing with multiple horizontal echogenic lines, caused by reverberation artefacts.
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2.3 Transverse image of the dorsal lung field in a 10-year-old Boston Terrier with mild pleural effusion. The lung surface (arrowheads) is not completely smooth and there is a small area of consolidation present in the superficial lung tissue, producing closely spaced linear echoes distally. This is called a comet tail artefact (arrowed).
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2.4 Right oblique intercostal view of the right caudal lung lobe in a 12-year-old Miniature Poodle bitch with metastatic mammary carcinoma. A round, hypoechoic nodule is present (arrowed), interrupting the normal lung surface (arrowhead). This would be amenable to fine-needle aspiration if required.
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2.5 Parasternal sagittal view of the caudoventral thorax in an adult crossbreed dog, the transducer is placed just lateral to the last sternebra. Between the heart (a) and the liver (b), outlined by a curvilinear hyperechoic line representing the diaphragm–lung interface, a small triangular area of fat can be seen in the caudal mediastinum (c).
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2.6 Oblique intercostal view of the right caudoventral thorax in a 5-year-old male Borzoi with pleural effusion secondary to idiopathic chylothorax. The heart (a) and a partially collapsed ventral tip of the right caudal lung lobe (b) are seen on the left. The caudal mediastinum is visible as an irregular, thin, hyperechoic structure (arrowed).
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2.7 Sagittal oblique view with the curvilinear probe slightly to the right side in the thoracic inlet. The jugular vein (a) can be seen entering the thorax and the tip of the right cranial lung lobe (b) is visible (easier to identify when respiratory movement can be observed).
Image of 2.8
2.8 Dorsal image of the cranial thorax of an 8-year-old neutered male Domestic Shorthair cat with pleural effusion. The whole width of the cranial thorax can be examined: thoracic wall (a), pleural space with anechoic effusion (b), collapsed lung lobe (c), cranial mediastinum (d), which is very thin without evidence of lymphadenopathy or other masses, and the heart (e).
Image of 2.9
2.9 Dorsal image of the cranial thorax of a 12-year-old neutered male crossbreed dog with pleural effusion. The cranial vena cava (a) and surrounding mediastinum with some fat are seen between the fluid-filled left and right pleural spaces (b).
Image of 2.10
2.10 Dorsal image of the cranial thorax of an obese dog, 2 cm dorsal to the sternum. The retrosternal fat is of medium echogenicity and without specific structures, apart from one hypoechoic tubular vessel. The thoracic wall is delineated with an arrow.
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2.11 Transverse right intercostal view (dorsal is to the left). The tip of the right cranial lung lobe (a), creating reverberation artefacts, and enlarged, rounded and hypoechoic lymph node (b), surrounded by hyperechoic fat, and the sternum, creating a distal acoustic shadows (c) are seen. The thoracic wall is labelled (d).
Image of 2.12
2.12 Sagittal image of the diaphragm, using the liver as acoustic window in a normal large-breed dog. The curvilinear probe is placed directly caudal to the xiphoid and angled cranially. The diaphragm–lung interface is seen as a continuous, bright, curvilinear structure covering the surface of the liver (arrowed).
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2.13 RPS and subcostal views. amv = Anterior mitral valve leaftlet; Ao = Aorta; AoV = Aortic valve; APM = Anterior papillary muscle; CW = Continuous wave; HCM = Hypertrophic cardiomyopathy; IAS = Interatrial septum; IVS = Interventricular septum; LA = Left atrium; LAu = Left auricular appendage; LPA = Left pulmonary artery; LV = Left ventricle; LVFW = Left ventricular free wall; LVOT = Left ventricular outflow tract; MPA = Main pulmonary artery; MV = Mitral valve; pmv = Posterior mitral valve leaflet; PPM = Posterior papillary muscle; PV = Pulmonic valve; PW = Pulsed wave; RA = Right atrium; RPA = Right pulmonary artery; RV = Right ventricle; RVOT = Right ventricular outflow tract; TV = Tricuspid valve; VSD = Ventricular septal defect. (Line diagrams adapted and reproduced from with permission from the publisher). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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2.14 Left apical and LPS views. Ao = Aorta; AoV = Aortic valve; CW = Continuous wave; IAS = Interatrial septum; IVS = Interventricular septum; LA = Left atrium; LPA = Left pulmonary artery; LV = Left ventricle; LVFW = Left ventricular free wall; LVOT = Left ventricular outflow tract; MPA = Main pulmonary artery; MV = Mitral valve; PDA = Patent ductus arteriosus; PV = Pulmonic valve; PW = Pulsed wave; pw-TDI = Pulsed wave tissue Doppler imaging; RA = Right atrium; RPA = Right pulmonary artery; RV = Right ventricle; RVOT = Right ventricular outflow tract; TV = Tricuspid valve. (Line diagrams adapted and reproduced from with permission from the publisher). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
Image of 2.15
2.15 M-mode views, measurements and calculations. AF = Atrial fibrillation; amv = Anterior mitral valve leaflet; Ao = Aorta; DCM = Dilated cardiomyopathy; ET = Ejection time; HCM = Hypertrophic cardiomyopathy; IVS = Interventricular septum; LA = Left atrium; LAu = Left auricular appendage; LV = Left ventricle; LVFW = Left ventricular free wall; LVID = Left ventricular internal dimension; MA = Mitral annulus; MAM = Mitral annulus motion; PEP = Pre-ejection period; pmv = Posterior mitral valve leaflet; RV = Right ventricle; SAM = Systolic anterior motion.
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2.16 Spectral Doppler echocardiography. amv = Anterior mitral valve leaflet; Ao = Aorta; AoR = Aortic regurgitation; CW = Continuous wave; ET = Ejection time; HCM = Hypertrophic cardiomyopathy; HPRF = High pulse repetition frequency; LA = Left atrium; LAu = Left auricular appendage; LV = Left ventricle; LVOT = Left ventricular outflow tract; MPA = Main pulmonary artery; MR = Mitral regurgitation; PDA = Patent ductus arteriosus; PEP = Pre-ejection period; PG = Pressure gradient; PI = Pulmonic insufficiency; PW = Pulsed wave; RA = Right atrium; RV = Right ventricle; RVOT = Right ventricular outflow tract; SAM = Systolic anterior motion; TR = Tricuspid regurgitation; VSD = Ventricular septal defect; VTI = Velocity time integral.
Image of 2.17
2.17 Assessment of systolic function. Ao = Aorta; Ao csa = Aortic cross-sectional area; CO = Cardiac output; CW = Continuous wave; DCM = Dilated cardiomyopathy; EDV = End-diastolic volume; EPSS = E point to septal separation; ESV = End-systolic volume; ET = Ejection time; HR= Heart rate; IVS = Interventricular septum; IVSd = Interventricular septal thickness in diastole; IVSs = Interventricular septal thickness in systole; LA = Left atrium; LV = Left ventricle; LVFW = Left ventricular free wall; LVFWd = Left ventricular free wall in diastole; LVFWs = Left ventricular free wall in systole; LVIDd = Left ventricular internal dimension in diastole; LVIDs = Left ventricular internal dimension in systole; MR = Mitral regurgitation; PEP = Pre-ejection period; PG = Pressure gradient; PW = Pulsed wave; SV = Stroke volume; VSD = Ventricular septal defect.
Image of 2.18
2.18 Assessment of diastolic function. AF = Atrial fibrillation; CW = Continuous wave; ET = Ejection time; HCM = Hypertrophic cardiomyopathy; HPRF = High pulse repetition frequency spectral Doppler ultrasonography; IMP = Index of myocardial performance; IVCT = Isovolumic contraction time; IVRT = Isovolumic relaxation time; LA = Left atrium; LPRF = Low pulse repetition frequency spectral Doppler ultrasonography; LV = Left ventricle; MR = Mitral regurgitation; MV = Mitral valve; MVC = Mitral valve closure; MVO = Mitral valve opening; PG = Pressure gradient; PVF = Pulmonary venous flow; PW = Pulsed wave; RV = Right ventricle; Vp = Propagation velocity of early filling; VTI = Velocity time integral.
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2.19 Pulsed wave tissue Doppler imaging assessment of myocardial function. HCM = Hypertrophic cardiomyopathy; IVC = Isovolumic contraction; IVCT = Isovolumic contraction time; IVR = Isovolumic relaxation; IVRT = Isovolumic relaxation time; LV = Left ventricle; LVFW = Left ventricular free wall; pw-TDI = Pulsed wave tissue Doppler imaging.
Image of 2.20
2.20 Lateral radiograph of a 76 kg, 5-year-old male neutered mixed-breed dog with recurrent pyrexia of unknown origin. The lungs were radiographically unremarkable and both transabdominal and transthoracic ultrasonography were unrewarding due to the large size of the dog. Lateral radiograph of a normal cadaver, showing placement of the ultrasound endoscope for examination of the caudal lung lobes and mediastinum. Endoscopic ultrasound image of the dog in (a), showing a heterogenous space-occupying lesion within the right caudal lung lobe. The margins are irregular and there is an expansile nature to the lesion seen by the pattern of air surrounding it. Lobectomy was performed and a chronic suppurative process with foreign material at its centre was diagnosed histologically.
Image of 2.21
2.21 Lateral radiograph of a 3 kg, 17-year-old female spayed cat with regurgitation and weight loss. A fairly well circumscribed soft tissue opaque lesion in the caudal thorax is shown with air-filled dilation of the oesophagus cranial to it. The lesion was shown to be midline on a ventrodorsal radiograph and suspected to be of mediastinal orgin, most likely the oesophagus. Endoscopic ultrasound image of a 5 cm homogenous space-occupying lesion (between white arrows), which involved the adjacent lung (+–+) as well as the oesophageal wall. Cytology of an endoscopic ultrasound-guided fine-needle aspirate of the lesion resulted in the diagnosis of oesophageal adenocarcinoma.
Image of 2.22
2.22 Olympus video endoscope. The scope is 1.25 m long with a multifrequency (5–10 MHz) linear transducer, 11.8 mm outer scope diameter at the insertional end and a 2.8 mm biopsy channel. Note that the endoscope is side-viewing (optics mounted at the side rather than the tip).

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