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fBasics of thoracic ultrasonography

image of Basics of thoracic ultrasonography

Abstract

Thoracic ultrasonography serves as a complementary imaging technique to radiography for assessment of non-air-filled structures. This chapter covers the myriad ultrasonographic views used in echocardiography, explaining the acquisition of each view as well as observations and measurements of interest, accompanied by examples of normal and pathological appearance. Additionally, assessments of cardiac structure, function and blood flow enabled by Doppler ultrasonography are discussed. The chapter also provides an overview of non-cardiac thoracic ultrasonography, including patient preparation, equipment selection and techniques for image acquisition.

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Figures

2.1 (a) Short-axis and (b) long-axis images of a normal canine rib, compared with (c) a long-axis image of a chronic rib fracture. Note the smooth hyperechoic surface of the normal rib (arrowed) whereas the fractured rib has an interrupted cortex (*) surrounded by hypoechoic callus (arrowheads). The body wall is characterized by alternating hyperechoic and hypoechoic layers.
2.2 Longitudinal image of a normal feline thorax using a linear array transducer. The ribs (*, displayed in short axis) cast a distal shadow. Note the striated appearance of the thoracic wall. The lung surface is a smooth, hyperechoic line (arrowed). Multiple echogenic lines parallel to the lung surface extending distal to the lung surface represent reverberation artefacts or A-lines.
2.3 Comet tail or B-line artefacts originating from the lung surface (arrowed) of a dog with suppurative inflammation of the lungs. Centrally, there is an area of lung consolidation present (arrowheads).
2.4 Lung lobe consolidation in a dog with pneumonia. The lung lobe has a ‘hepatized’ appearance with a central residual gas pocket (arrowed).
2.5 Multiple hypoechoic nodules along the lung surface (arrowed) of a Maltese with metastatic carcinoma.
2.6 Subxiphoidal long-axis view of the diaphragm and caudal mediastinum in a cat without thoracic disease. The diaphragm is represented by a curvilinear hyperechoic line (arrowed). The tissue cranial to the diaphragm represents a mirror image artefact and not mediastinal pathology; note the symmetry of the structures within this tissue with the liver.
2.7 Longitudinal images of the caudal mediastinum of a cat using a subcostal approach. (a) The caudal thoracic oesophagus and gastro-oesophageal junction are visible (arrowed). (b) The caudal vena cava (arrowed) is surrounded by pleural effusion. A portion of the consolidated accessory lung lobe (*) is surrounded by fluid as well. Histopathology of the accessory lung lobe and cytology of pleural fluid were consistent with carcinoma.
2.8 Transverse view of the thoracic inlet in a dog with ectopic thyroid carcinoma (indicated by calipers). The trachea is a curvilinear structure with distal reverberation artefact (arrowed). The adjacent round hypoechoic structure is the common carotid artery (*).
2.9 Longitudinal parasternal view of the cranial thorax of a cat with pleural effusion. The entire width of the cranial thorax is visible: the thoracic wall (A), pleural space with anechoic effusion (B), collapsed cranial lung lobes (C), cranial mediastinum (D), which is very thin without evidence of lymphadenopathy or fat, and the heart (E).
2.10 Longitudinal parasternal view of the cranial thorax of a cat with bilateral chylous pleural effusion (*) and thrombosis of the cranial vena cava (indicated by calipers).
2.11 Parasternal long-axis view immediately dorsal to the sternum in a Labrador Retriever with acute myeloid leukaemia. The sternal lymph node is enlarged, rounded and hypoechoic (arrowed).
2.12 Parasternal intercostal transverse view of the cranial mediastinum in an obese dog. The mediastinum is wide due to fat deposition (indicated by calipers). The fat is hypoechoic with a coarse structure. A vessel is visible centrally (arrowed).
2.13 Longitudinal image of the liver and diaphragm in a cat with bicavitary effusion. The diaphragm is outlined by peritoneal and pleural effusion (arrowed).
2.14 Fine-needle aspiration of a pulmonary nodule using a 22 G needle. The needle (seen on the left side of the image) is inserted through the body wall and into the pulmonary nodule.
2.15 Part A Right parasternal (RPS) and subcostal views - Right parasternal long-axis four-chamber view. amv = anterior mitral valve leaflet; Ao = aorta; AoV = aortic valve; APM = anterior papillary muscle; CdVC = caudal vena cava; CW = continuous wave; DCM = dilated cardiomyopathy; HCM = hypertrophic cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MV = mitral valve; pmv = posterior mitral valve leaflet; PPM = posterior papillary muscle; PV = pulmonic valve; PVe = pulmonary vein; PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPA = right pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract; TV = tricuspid valve; VSD = ventricular septal defect. (Line diagram adapted and reproduced from with permission from the publisher)
2.15 Part B Right parasternal (RPS) and subcostal views - Right parasternal long-axis five-chamber view. amv = anterior mitral valve leaflet; Ao = aorta; AoV = aortic valve; APM = anterior papillary muscle; CdVC = caudal vena cava; CW = continuous wave; DCM = dilated cardiomyopathy; HCM = hypertrophic cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MV = mitral valve; pmv = posterior mitral valve leaflet; PPM = posterior papillary muscle; PV = pulmonic valve; PVe = pulmonary vein; PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPA = right pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract; TV = tricuspid valve; VSD = ventricular septal defect. (Line diagram adapted and reproduced from with permission from the publisher)
2.15 Part C Right parasternal (RPS) and subcostal views - Right parasternal short-axis view. amv = anterior mitral valve leaflet; Ao = aorta; AoV = aortic valve; APM = anterior papillary muscle; CdVC = caudal vena cava; CW = continuous wave; DCM = dilated cardiomyopathy; HCM = hypertrophic cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MV = mitral valve; pmv = posterior mitral valve leaflet; PPM = posterior papillary muscle; PV = pulmonic valve; PVe = pulmonary vein; PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; 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)
2.15 Part D Right parasternal (RPS) and subcostal views - Right parasternal cranial long-axis view of aorta. amv = anterior mitral valve leaflet; Ao = aorta; AoV = aortic valve; APM = anterior papillary muscle; CdVC = caudal vena cava; CW = continuous wave; DCM = dilated cardiomyopathy; HCM = hypertrophic cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MV = mitral valve; pmv = posterior mitral valve leaflet; PPM = posterior papillary muscle; PV = pulmonic valve; PVe = pulmonary vein; PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPA = right pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract; TV = tricuspid valve; VSD = ventricular septal defect.
2.15 Part E Right parasternal (RPS) and subcostal views - Right parasternal cranial short-axis view. amv = anterior mitral valve leaflet; Ao = aorta; AoV = aortic valve; APM = anterior papillary muscle; CdVC = caudal vena cava; CW = continuous wave; DCM = dilated cardiomyopathy; HCM = hypertrophic cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MV = mitral valve; pmv = posterior mitral valve leaflet; PPM = posterior papillary muscle; PV = pulmonic valve; PVe = pulmonary vein; PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPA = right pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract; TV = tricuspid valve; VSD = ventricular septal defect. (Line diagram adapted and reproduced from with permission from the publisher)
2.15 Part F Right parasternal (RPS) and subcostal views - Subcostal view. amv = anterior mitral valve leaflet; Ao = aorta; AoV = aortic valve; APM = anterior papillary muscle; CdVC = caudal vena cava; CW = continuous wave; DCM = dilated cardiomyopathy; HCM = hypertrophic cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MV = mitral valve; pmv = posterior mitral valve leaflet; PPM = posterior papillary muscle; PV = pulmonic valve; PVe = pulmonary vein; PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPA = right pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract; TV = tricuspid valve; VSD = ventricular septal defect.
2.16 Part A The left apical and parasternal views - Left apical four-chamber view. Ao = aorta; AoV = aortic valve; CW = continuous wave; FAC = fractional area change; HOCM = hypertrophic obstructive cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MAPSE = mitral annulus plane systolic excursion; MPA = main pulmonary artery (pulmonic trunk); 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; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion; TV = tricuspid valve; Vp = left ventricular early flow propagation velocity. (Line diagram adapted and reproduced from with permission from the publisher)
2.16 Part B The left apical and parasternal views - Left apical five-chamber view. Ao = aorta; AoV = aortic valve; CW = continuous wave; FAC = fractional area change; HOCM = hypertrophic obstructive cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MAPSE = mitral annulus plane systolic excursion; MPA = main pulmonary artery (pulmonic trunk); 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; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion; TV = tricuspid valve; Vp = left ventricular early flow propagation velocity. (Line diagram adapted and reproduced from with permission from the publisher)
2.16 Part C The left apical and parasternal views - Left apical two-chamber view. Ao = aorta; AoV = aortic valve; CW = continuous wave; FAC = fractional area change; HOCM = hypertrophic obstructive cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MAPSE = mitral annulus plane systolic excursion; MPA = main pulmonary artery (pulmonic trunk); 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; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion; TV = tricuspid valve; Vp = left ventricular early flow propagation velocity.
2.16 Part D The left apical and parasternal views - Left apical three-chamber view. Ao = aorta; AoV = aortic valve; CW = continuous wave; FAC = fractional area change; HOCM = hypertrophic obstructive cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MAPSE = mitral annulus plane systolic excursion; MPA = main pulmonary artery (pulmonic trunk); 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; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion; TV = tricuspid valve; Vp = left ventricular early flow propagation velocity.
2.16 Part E The left apical and parasternal views - Left cranial parasternal long-axis view of the aorta. Ao = aorta; AoV = aortic valve; CW = continuous wave; FAC = fractional area change; HOCM = hypertrophic obstructive cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MAPSE = mitral annulus plane systolic excursion; MPA = main pulmonary artery (pulmonic trunk); 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; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion; TV = tricuspid valve; Vp = left ventricular early flow propagation velocity. (Line diagram adapted and reproduced from with permission from the publisher)
2.16 Part F The left apical and parasternal views - Left cranial parasternal short-axis view optimizing the pulmonic trunk. Ao = aorta; AoV = aortic valve; CW = continuous wave; FAC = fractional area change; HOCM = hypertrophic obstructive cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MAPSE = mitral annulus plane systolic excursion; MPA = main pulmonary artery (pulmonic trunk); 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; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion; TV = tricuspid valve; Vp = left ventricular early flow propagation velocity. (Line diagram adapted and reproduced from with permission from the publisher)
2.16 Part G The left apical and parasternal views - Left cranial parasternal short-axis view (left atrial appendage). Ao = aorta; AoV = aortic valve; CW = continuous wave; FAC = fractional area change; HOCM = hypertrophic obstructive cardiomyopathy; IAS = interatrial septum; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; L-CHF = left-sided congestive heart failure; LPA = left pulmonary artery; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MAPSE = mitral annulus plane systolic excursion; MPA = main pulmonary artery (pulmonic trunk); 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; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion; TV = tricuspid valve; Vp = left ventricular early flow propagation velocity
2.17 Part A M-mode views, measurements and calculations - Left ventricular M-mode (chordae tendinae level). amv = anterior mitral valve leaflet; Ao = aorta; AoR = aortic regurgitation; DCM = dilated cardiomyopathy; ECG = electrocardiogram; EPSS = mitral valve E point to septal separation; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LAA = left atrial appendage; LPA = left pulmonary artery; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; MA = mitral annulus; MAPSE = mitral annulus plane systolic excursion; PEP = pre-ejection period; pmv = posterior mitral valve leaflet; RA = right atrium; RPA = right pulmonary artery; RPS = right parasternal; RV = right ventricle; RVFW = right ventricular free wall; SAM = systolic anterior motion; TAPSE = tricuspid annulus plane systolic excursion.
2.17 Part B M-mode views, measurements and calculations - Mitral valve M-mode. amv = anterior mitral valve leaflet; Ao = aorta; AoR = aortic regurgitation; DCM = dilated cardiomyopathy; ECG = electrocardiogram; EPSS = mitral valve E point to septal separation; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LAA = left atrial appendage; LPA = left pulmonary artery; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; MA = mitral annulus; MAPSE = mitral annulus plane systolic excursion; PEP = pre-ejection period; pmv = posterior mitral valve leaflet; RA = right atrium; RPA = right pulmonary artery; RPS = right parasternal; RV = right ventricle; RVFW = right ventricular free wall; SAM = systolic anterior motion; TAPSE = tricuspid annulus plane systolic excursion.
2.17 Part C M-mode views, measurements and calculations - M-mode at aortic valve level. amv = anterior mitral valve leaflet; Ao = aorta; AoR = aortic regurgitation; DCM = dilated cardiomyopathy; ECG = electrocardiogram; EPSS = mitral valve E point to septal separation; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LAA = left atrial appendage; LPA = left pulmonary artery; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; MA = mitral annulus; MAPSE = mitral annulus plane systolic excursion; PEP = pre-ejection period; pmv = posterior mitral valve leaflet; RA = right atrium; RPA = right pulmonary artery; RPS = right parasternal; RV = right ventricle; RVFW = right ventricular free wall; SAM = systolic anterior motion; TAPSE = tricuspid annulus plane systolic excursion.
2.17 Part D M-mode views, measurements and calculations - Mitral annular plan systolic excursion (also known as mitral annulus motion). amv = anterior mitral valve leaflet; Ao = aorta; AoR = aortic regurgitation; DCM = dilated cardiomyopathy; ECG = electrocardiogram; EPSS = mitral valve E point to septal separation; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LAA = left atrial appendage; LPA = left pulmonary artery; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; MA = mitral annulus; MAPSE = mitral annulus plane systolic excursion; PEP = pre-ejection period; pmv = posterior mitral valve leaflet; RA = right atrium; RPA = right pulmonary artery; RPS = right parasternal; RV = right ventricle; RVFW = right ventricular free wall; SAM = systolic anterior motion; TAPSE = tricuspid annulus plane systolic excursion.
2.17 Part E M-mode views, measurements and calculations - Tricuspid annular plane systolic excursion. amv = anterior mitral valve leaflet; Ao = aorta; AoR = aortic regurgitation; DCM = dilated cardiomyopathy; ECG = electrocardiogram; EPSS = mitral valve E point to septal separation; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LAA = left atrial appendage; LPA = left pulmonary artery; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; MA = mitral annulus; MAPSE = mitral annulus plane systolic excursion; PEP = pre-ejection period; pmv = posterior mitral valve leaflet; RA = right atrium; RPA = right pulmonary artery; RPS = right parasternal; RV = right ventricle; RVFW = right ventricular free wall; SAM = systolic anterior motion; TAPSE = tricuspid annulus plane systolic excursion.
2.18 Part A Spectral and colour flow Doppler echocardiography - Transmitral flow. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part B Spectral and colour flow Doppler echocardiography - Mitral regurgitation. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part C Spectral and colour flow Doppler echocardiography - Left ventricular outflow and aortic flow. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part D Spectral and colour flow Doppler echocardiography - Dynamic left ventricular outflow tract obstruction. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part E Spectral and colour flow Doppler echocardiography - Aortic regurgitation. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part F Spectral and colour flow Doppler echocardiography - Tricuspid flow. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part G Spectral and colour flow Doppler echocardiography - Tricuspid regurgication. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part H Spectral and colour flow Doppler echocardiography - Pulmonic flow. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.18 Part I Spectral and colour flow Doppler echocardiography - Pulmonic regurgitation/pulmonic insufficiency. Ao = aorta; AoO = aortic outflow; AoR = aortic regurgitation; CHF = congestive heart failure; CW = continuous wave; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IVS = interventricular septum; LA = left atrium; LAA = left atrial appendage; LPS = left parasternal; LV = left ventricle; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MPA = main pulmonary artery (pulmonic trunk); MR = mitral regurgitation; MV = mitral valve; PDA = patent ductus arteriosus; PEP = pre-ejection period; PG = pressure gradient; PI = pulmonic insufficiency (regurgitation); PW = pulsed wave; RA = right atrium; R-CHF = right-sided congestive heart failure; RPS = right parasternal; RV = right ventricle; RVOT = right ventricular outflow tract; SAM = systolic anterior motion; TR = tricuspid regurgitation; TV = tricuspid valve; v = velocity; VSD = ventricular septal defect; VTI = velocity time integral.
2.19 Part A Assessment of left ventricular systolic function - M-mode assessment of systolic function. Ao = aorta; BSA = body surface area; CO = cardiac output; csa = cross-sectional area; CW = continuous wave; DCM = dilated cardiomyopathy; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; EDV = end-diastolic volume (of the left ventricle); EF = ejection fraction; EPSS = mitral valve E point to septal separation; ESV = end-systolic volume; ESVI = end-systolic volume index; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HR = heart rate; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; LVpw = left ventricular posterior wall; MAPSE = mitral annulus plane systolic excursion; MR = mitral regurgitation; PEP = pre-ejection period; PG = pressure gradient; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; SV = stroke volume; Vcf = velocity of circumferential fibre shortening; VSD = ventricular septal defect; VTI = velocity time integral.
2.19 Part B Assessment of left ventricular systolic function - 2D assessment of LV systolic function. Ao = aorta; BSA = body surface area; CO = cardiac output; csa = cross-sectional area; CW = continuous wave; DCM = dilated cardiomyopathy; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; EDV = end-diastolic volume (of the left ventricle); EF = ejection fraction; EPSS = mitral valve E point to septal separation; ESV = end-systolic volume; ESVI = end-systolic volume index; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HR = heart rate; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; LVpw = left ventricular posterior wall; MAPSE = mitral annulus plane systolic excursion; MR = mitral regurgitation; PEP = pre-ejection period; PG = pressure gradient; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; SV = stroke volume; Vcf = velocity of circumferential fibre shortening; VSD = ventricular septal defect; VTI = velocity time integral.
2.19 Part C Assessment of left ventricular systolic function - Doppler assessment of LV systolic function from aortic outflow. Ao = aorta; BSA = body surface area; CO = cardiac output; csa = cross-sectional area; CW = continuous wave; DCM = dilated cardiomyopathy; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; EDV = end-diastolic volume (of the left ventricle); EF = ejection fraction; EPSS = mitral valve E point to septal separation; ESV = end-systolic volume; ESVI = end-systolic volume index; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HR = heart rate; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; LVpw = left ventricular posterior wall; MAPSE = mitral annulus plane systolic excursion; MR = mitral regurgitation; PEP = pre-ejection period; PG = pressure gradient; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; SV = stroke volume; Vcf = velocity of circumferential fibre shortening; VSD = ventricular septal defect; VTI = velocity time integral.
2.19 Part D Assessment of left ventricular systolic function - Doppler assessment of LV systolic function from mitral regurgitant jet. Ao = aorta; BSA = body surface area; CO = cardiac output; csa = cross-sectional area; CW = continuous wave; DCM = dilated cardiomyopathy; dP = pressure difference; dt = time difference; dv = velocity difference; ECG = electrocardiogram; EDV = end-diastolic volume (of the left ventricle); EF = ejection fraction; EPSS = mitral valve E point to septal separation; ESV = end-systolic volume; ESVI = end-systolic volume index; ET = left ventricular ejection time; FS = fractional shortening; HCM = hypertrophic cardiomyopathy; HR = heart rate; IVS (with d or s) = interventricular septum (in diastole or systole); LA = left atrium; LV = left ventricle; LVFW (with d or s) = left ventricular free wall (in diastole or systole); LVID (with d or s) = left ventricular internal diameter (in diastole or systole); LVOT = left ventricular outflow tract; LVpw = left ventricular posterior wall; MAPSE = mitral annulus plane systolic excursion; MR = mitral regurgitation; PEP = pre-ejection period; PG = pressure gradient; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; SV = stroke volume; Vcf = velocity of circumferential fibre shortening; VSD = ventricular septal defect; VTI = velocity time integral.
2.20 Part A The Doppler assessment of left ventricular diastolic function - PW Doppler measurement of isovolumic relaxation time. Ao = aorta; Ar = atrial reversal wave; CHF = congestive heart failure; CW = continuous wave; D = diastolic flow (PVF); dP = pressure difference; dt = time difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IMP = index of myocardial performance (Tei index); IVCT = isovolumic contraction time; IVRT = isovolumic relaxation time; LA = left atrium; L-CHF = left-sided congestive heart failure; LPRF = low pulse repetition frequency; LV = left ventricle; LVOT = left ventricular outflow tract; MR = mitral regurgitation; MV = mitral valve; MVC = mitral valve closure; MVO = mitral valve opening; PVF = pulmonary venous flow; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; S = systolic flow (PVF; Se = early flow; SI = main flow wave); Vp = left ventricular early flow propagation velocity.
2.20 Part B The Doppler assessment of left ventricular diastolic function - PW Doppler measurement of transmitral flow. Ao = aorta; Ar = atrial reversal wave; CHF = congestive heart failure; CW = continuous wave; D = diastolic flow (PVF); dP = pressure difference; dt = time difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IMP = index of myocardial performance (Tei index); IVCT = isovolumic contraction time; IVRT = isovolumic relaxation time; LA = left atrium; L-CHF = left-sided congestive heart failure; LPRF = low pulse repetition frequency; LV = left ventricle; LVOT = left ventricular outflow tract; MR = mitral regurgitation; MV = mitral valve; MVC = mitral valve closure; MVO = mitral valve opening; PVF = pulmonary venous flow; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; S = systolic flow (PVF; Se = early flow; SI = main flow wave); Vp = left ventricular early flow propagation velocity.
2.20 Part C The Doppler assessment of left ventricular diastolic function - PW Doppler measurement of pulmonary venous flow. Ao = aorta; Ar = atrial reversal wave; CHF = congestive heart failure; CW = continuous wave; D = diastolic flow (PVF); dP = pressure difference; dt = time difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IMP = index of myocardial performance (Tei index); IVCT = isovolumic contraction time; IVRT = isovolumic relaxation time; LA = left atrium; L-CHF = left-sided congestive heart failure; LPRF = low pulse repetition frequency; LV = left ventricle; LVOT = left ventricular outflow tract; MR = mitral regurgitation; MV = mitral valve; MVC = mitral valve closure; MVO = mitral valve opening; PVF = pulmonary venous flow; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; S = systolic flow (PVF; Se = early flow; SI = main flow wave); Vp = left ventricular early flow propagation velocity.
2.20 Part D The Doppler assessment of left ventricular diastolic function - Diastolic function from mitral regurgitant jet. Ao = aorta; Ar = atrial reversal wave; CHF = congestive heart failure; CW = continuous wave; D = diastolic flow (PVF); dP = pressure difference; dt = time difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IMP = index of myocardial performance (Tei index); IVCT = isovolumic contraction time; IVRT = isovolumic relaxation time; LA = left atrium; L-CHF = left-sided congestive heart failure; LPRF = low pulse repetition frequency; LV = left ventricle; LVOT = left ventricular outflow tract; MR = mitral regurgitation; MV = mitral valve; MVC = mitral valve closure; MVO = mitral valve opening; PVF = pulmonary venous flow; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; S = systolic flow (PVF; Se = early flow; SI = main flow wave); Vp = left ventricular early flow propagation velocity.
2.20 Part E The Doppler assessment of left ventricular diastolic function - Velocity of propagation of mitral flow from mitral annulus towards the LV apex. Ao = aorta; Ar = atrial reversal wave; CHF = congestive heart failure; CW = continuous wave; D = diastolic flow (PVF); dP = pressure difference; dt = time difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IMP = index of myocardial performance (Tei index); IVCT = isovolumic contraction time; IVRT = isovolumic relaxation time; LA = left atrium; L-CHF = left-sided congestive heart failure; LPRF = low pulse repetition frequency; LV = left ventricle; LVOT = left ventricular outflow tract; MR = mitral regurgitation; MV = mitral valve; MVC = mitral valve closure; MVO = mitral valve opening; PVF = pulmonary venous flow; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; S = systolic flow (PVF; Se = early flow; SI = main flow wave); Vp = left ventricular early flow propagation velocity.
2.20 Part F The Doppler assessment of left ventricular diastolic function - Index of myocardial performance (the Tei index). Ao = aorta; Ar = atrial reversal wave; CHF = congestive heart failure; CW = continuous wave; D = diastolic flow (PVF); dP = pressure difference; dt = time difference; ECG = electrocardiogram; ET = left ventricular ejection time; HCM = hypertrophic cardiomyopathy; HOCM = hypertrophic obstructive cardiomyopathy; HPRF = high pulse repetition frequency; IMP = index of myocardial performance (Tei index); IVCT = isovolumic contraction time; IVRT = isovolumic relaxation time; LA = left atrium; L-CHF = left-sided congestive heart failure; LPRF = low pulse repetition frequency; LV = left ventricle; LVOT = left ventricular outflow tract; MR = mitral regurgitation; MV = mitral valve; MVC = mitral valve closure; MVO = mitral valve opening; PVF = pulmonary venous flow; PW = pulsed wave; RA = right atrium; RPS = right parasternal; RV = right ventricle; S = systolic flow (PVF; Se = early flow; SI = main flow wave); Vp = left ventricular early flow propagation velocity.
2.21 Pulsed wave tissue Doppler imaging (PW-TDI) assessment of myocardial function (longitudinal fibres). HCM = hypertrophic cardiomyopathy; IVC = isovolumic contraction; IVCT = isovolumic contraction time; IVR = isovolumic relaxation; IVRT = isovolumic relaxation time; IVS = interventricular septum; LV = left ventricle; LVFW = left ventricular free wall; MMVD = myxomatous mitral valve disease.
2.22 Estimation of left-sided filling pressures. Ar = atrial reversal wave; CW = continuous wave; DCM = dilated cardiomyopathy; IVRT = isovolumic relaxation time; IVS = interventricular septum; LA = left atrium; LPRF = low pulse repetition frequency; LV = left ventricle; LVFW = left ventricular free wall; LVOT = left ventricular outflow tract; MMVD = myxomatous mitral valve disease; MV = mitral valve; PVe = pulmonary vein; PVF = pulmonary venous flow; PW = pulsed wave; PW-TDI = pulsed wave tissue Doppler imaging; RPA = right pulmonary artery; RPS = right parasternal; Vp = left ventricular early flow propagation velocity.
2.23 Assessment of right ventricular systolic function. CHF = congestive heart failure; FAC = fractional area change; HCM = hypertrophic cardiomyopathy; PW-TDI = pulsed wave tissue Doppler imaging; RV = right ventricle; RVA (with s or d) = right ventricle area (in systole or diastole); RVFW = right ventricular free wall; RVOT = right ventricular outflow tract; TAPSE = tricuspid annulus plane systolic excursion.
2.24 (a) Lateral thoracic radiograph of a canine cadaver, showing placement of the ultrasound endoscope for examination of the caudal lung lobes and mediastinum. (b) Lateral thoracic radiograph of a 76 kg, 5-year-old neutered male 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. (c) Endoscopic ultrasound image of the dog in (b), showing a heterogeneous 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.
2.25 (a) Lateral thoracic radiograph of a 3 kg, 17-year-old neutered female 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 originate in the mediastinum, most likely the oesophagus.  (b) Endoscopic ultrasound image of a 5 cm homogeneous space-occupying lesion (between arrows), which involved the adjacent lung (indicated by calipers) 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.
2.26 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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