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Abdomen

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Abstract

Ultrasonography of the abdomen is indicated in the evaluation of many conditions, and can be categorized as either emergency evaluation or elective abdominal ultrasonography. In many cases ultrasonography will be used as an adjunct to radiographic evaluation. This chapters looks at indications and the value of ultrasonography compared with radiography and advanced imaging modalities before moving on to addressing imaging technique and normal ultrasonographic appearance. Abnormal conditions and Retroperitoneal conditions are covered. This chapter contains nine video clips.

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Figures

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7.1 Positioning for lateral recumbent abdominal ultrasonography. It is recommended that the animal be scanned from both sides and therefore turned part-way through the examination. Positioning for dorsal recumbent abdominal ultrasonography. A padded trough makes positioning easier and more comfortable for the animal.
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7.2 Depth misregistration due to falciform fat. There is an artefactual discontinuity of the diaphragm (arrowed). Mirror image artefact, giving the appearance of the liver and gallbladder on the thoracic side of the diaphragm.
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7.3 Normal appearance of the mesentery. The spleen is superficially in this image and has normal mesentery adjacent to it.
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7.4 Abdominal lymph nodes.1 = hepatic; 2 = gastric;3 = pancreaticoduodenal; 4 = colic;5 = jejunal; 6 = splenic; 7 = renal;8 = lumbar aortic; 9 = medial iliac;10 = hypogastric; 11 = sacral. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.6 Normal jejunal lymph node (arrowed) demonstrating the fusiform shape. Hepatic lymph node (arrowed) seen adjacent to the portal vein. This node has a small cyst-like area within it. Normal medial iliac lymph node (arrowed) in a 5-year-old Cocker Spaniel. The caudal vena cava is seen deep to the node.
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7.7 Major abdominal vessels.1 = caudal vena cava;2 = renal vein; 3 = circumflex iliac vein; 4 = external iliac vein; 5 = internal iliac vein; 6 = aorta; 7 = coeliac artery; 8 = cranial mesenteric artery; 9 = phrenicoabdominal artery; 10 = renal artery; 11 = circumflex iliac artery;12 = external iliac artery;13 = internal iliac artery; 14 = portal vein; 15 = gastroduodenal vein;16 = splenic vein; 17 = left gastric vein; 18 = cranial mesenteric vein. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.8 Normal caudal vena cava and aorta at their bifurcation.
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7.9 PW Doppler ultrasonograms. Normalcaudal vena cava at the diaphragm. Normal portal vein.
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7.10 Abdominal wall lipoma (arrowed) in a 12-year-old Labrador Retriever.
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7.11 Heterogeneous cavitated mass in the inguinal region of an 11-year-old mixed-breed dog. This was diagnosed as an undifferentiated sarcoma. Cutaneous haemangiosarcoma in a 9-year-old Labrador Retriever. The lesion crossed the abdominal wall and displaced the right kidney.
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7.12 Echogenic effusion surrounding the small intestines in a 10-year-old Golden Retriever with a haemoabdomen secondary to a splenic haemangiosarcoma. Anechoic fluid adjacent to the urinary bladder in a dog with ascites secondary to cirrhosis and portal hypertension. Echogenic effusion adjacent to the urinary bladder in a dog with peritonitis.
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7.13 Focal peritoneal free gas (labelled) in a dog with duodenal perforation secondary to ulceration. The gas bubble (arrowed) is associated with a reverberation artefact.
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7.15 Hyperechoic mesentery adjacent to the duodenum in a dog with localized peritonitis due to pancreatitis. The inflamed pancreas is seen deep to the duodenum, but is poorly defined due to shadowing from the inflamed mesentery.
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7.16 Abdominal carcinomatosis secondary to ovarian carcinoma in a 7-year-old Shih Tzu bitch. The echogenic fluid is characteristic of carcinomatosis. Focal peritoneal masses. Masses along the median ligament of the bladder.
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7.17 Mass in the omentum (arrowed) adjacent to the gastric fundus in a 7-year-old Bernese Mountain Dog. The mass was diagnosed as a histiocytic sarcoma by ultrasound-guided fine-needle aspiration.
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7.18 An enlarged and irregular jejunal lymph node with a hypoechoic rim in a 9-year-old Rottweiler with lymphosarcoma. The adjacent mesentery is hyperechoic. An enlarged, rounded and hypoechoic right medial iliac lymph node in an 11-year-old mixed-breed dog with prostatic carcinoma. The lymph node was aspirated under ultrasound guidance and confirmed to be infiltrated with metastatic neoplasia.
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7.19 Thrombus in the splenic vein of a 7-year-old Dobermann with renal failure. Splenic vein thrombus in an 8-year-old Shih Tzu with immune-mediated haemolytic anaemia. Note the echogenic filling defect in the lumen of the vessel.
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7.20 Echogenic blood flow in the caudal vena cava (CVC) of an 8-year-old Shih Tzu with immune-mediated haemolytic anaemia. Thrombi (arrowed) were located in the portal and splenic veins, but blood flow was continuous in the cava.
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7.21 Mass (arrowed) in the caudal vena cava (CVC) of an 8-year-old Golden Retriever with lymphosarcoma. On necropsy the mass was confirmed to be an extension of a lymph node malignancy into the vessel.
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7.22 Retroperitoneal haemangiosarcoma (arrowed) adjacent to the kidney in a 10-year-old mixed-breed dog.

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Normal mesentery.

This clip shows normal mesentery adjacent to the spleen in an 11-year-old mixed-breed dog. The stomach lies to the left of the image (cranially) and the spleen is superficial. The hyperechoic regions adjacent to the splenic vessels were considered to represent incidental myelolipomas.

Peritoneal effusion.

An echogenic peritoneal effusion is shown in a dog with haemoabdomen secondary to a ruptured haemangiosarcoma. The swirling echogenicity characteristically occurs with an acute haemorrhagic effusion.

Postsurgical hernia.

This clip shows dehiscence of the linea alba following enterotomy in a 6-month-old dog. At the start of the clip the fusiform bellies of the abdominal muscles are seen lying superficially, almost touching in the mid-line. As the clip progresses, this normal orderly arrangement is seen to become disrupted and the muscle bellies become widely separated.

Changes to the mesentery.

This clip shows hyperechoic mesentery adjacent to a mass associated with the pancreas in a cat with lymphosarcoma. Such changes may be associated with inflammation or with diffuse neoplastic infiltration. A section of the duodenum is seen at the top left-hand side of the image.

Enlarged abdominal lymph nodes (1).

Enlarged, rounded and hypoechoic colic lymph nodes are present in a 1-year-old cat with feline infectious peritonitis. These lymph nodes are located at the ileocolic junction.

Enlarged abdominal lymph nodes (2).

This clip shows similarly enlarged, rounded and hypoechoic hepatic and pancreaticoduodenal nodes in the same cat as in Enlarged abdominal lymph nodes (1).

Splenic thrombi.

Thrombi are seen in the splenic veins of a dog with immune-mediated haemolytic anemia. The thrombi are mildly echogenic but show most clearly as filling defects within the vessel when Power Doppler is used.

‘Smoke’ in the caudal vena cava.

The caudal vena cava in this dog runs transversely across the image. These images show echogenic ‘smoke’ within the lumen of the vessel. The dog had immune-mediated haemolytic anemia and was in a known hypercoagulable state.

Retroperitoneal effusion.

This clip demonstrates fluid within the retroperitoneal space of a 2-year-old Labrador Retriever with acute renal inflammation due to leptospirosis. The clip begins centred on the kidney itself, then moves more caudally.

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