Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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22 Small Animal Radiolo g y and Ultrasono graphy ultrasonographic abnormalities. Diagnoses should include all possible etiologies: toxic, infectious, metabolic, nutritional, degenerative, neoplastic, iatrogenic, immune, idiopathic, and developmental. The probable diagnosis usually is based on determining which of the differential diagnoses can produce all of the radiographic or ultrasonographic abnormalities observed. This probable diagnosis may be specific or general. An example of a specific diagnosis might be a bone tumor (most likely osteosarcoma) in the case of an aggressive but mixed (destructive and proliferative) lesion with a sunburst pattern in the distal radius of a 9-year-old male Saint Bernard, or a renal cyst in the case of a focal anechoic area within the kidney. A general diagnosis would be an enlarged kidney in a 5-year-old mixed breed female dog, or increased echogenicity of the liver in a cat with hepatomegaly. RECOMMENDATION FOR FURTHER DIAGNOSTIC MODALITIES OR THERAPY Once a radiographic or ultrasonographic diagnosis is reached, a program for confirmation of the diagnosis or for treatment of the problem should be developed. This step is the result to which the radiographic or ultrasonographic examination is properly oriented. One caveat of the radiographic or the ultrasonographic diagnosis is that lesion appearance is neither cytologically nor histologically specific. Further techniques that commonly are indicated include additional diagnostic imaging procedures, hematologic or biochemical blood evaluations, endoscopy, fine-needle aspiration, ultrasonographically guided fine-needle aspiration or core tissue biopsy, or surgical exploration. Treatment plans might include pharmacologic therapies (e.g., antibiotics for pneumonia) or surgical treatments (e.g., partial ligation of portosystemic shunts). Another caveat of imaging diagnoses is that unless a wide array of possible differential diagnoses are considered and an organized sequential plan to confirm or refute these is developed, the appropriate test may not be run or the necessary further diagnostic modalities might not be pursued. Therefore the formulation of a broad, but ranked, list of differential diagnoses based on the combination of signalment (age, breed, gender), history, physical examination findings, morphologic alterations observed via imaging, and any other available information is a critical step in patient evaluation. In addition, it may be these differential possibilities that justify the imaging modalities used and their sequence. REFERENCES 1. Schnelle GB: Radiology in canine practice. The North American Veterinarian, Evanston, Ill, 1945. 2. McGahan JP, Goldberg BB: Diagnostic ultrasound: a logical approach. Lippincott–Raven, Philadelphia, 1998. 3. Miles KG: Basic principles and clinical applications of diagnostic ultrasound. Comp Cont Educ Pract Vet 1989; 11:609. 4. Nyland GT, Mattoon J: Veterinary diagnostic ultrasonography. WB Saunders, Philadelphia, 2001. 5. Kaplan PM, Murtaugh RJ, Ross JN: Ultrasound in emergency veterinary medicine. Semin Vet Med Surg 1988; 3:245. 6. Curry TS, Dowdey JE, Murry RC: Christensen’s physics of diagnostic radiology, ed 4. Lea & Febiger, Philadelphia, 1990. 7. Feeney DA, Fletcher TF, Hardy RM: Atlas of correlative imaging anatomy of the normal dog: ultrasound and computed tomography. WB Saunders, Philadelphia, 1991. 8. Herring DS, Bjornton G: Physics, facts, and artifacts of diagnostic ultrasound. Vet Clin North Am 1985; 15:1107. 9. Kremkau FW: Diagnostic ultrasound: principles, instruments and exercises, ed 5. WB Saunders, Philadelphia, 1998. 10. Barthez PY, Leveille R, Scrivani PV: Side lobes and grating lobes artifacts in ultrasound imaging. Vet Radiol Ultrasound 1997; 38:387. 11. Douglass JP, Kermkau FW: The urinary bladder wall hypoechoic pseudolesion. Vet Radiol Ultrasound 1993; 34:45. 12. Kirberger RM: Imaging artifacts in diagnostic ultrasound: a review. Vet Radiol Ultrasound 1995; 36:297. 13. Lamb CR, Boswood A: Ultrasound corner—an artifact resulting from propagation speed error. Vet Radiol Ultrasound 1995; 36:549. 14. Widmer WR, Kneller SK: Artifacts and technical errors presented as part of the 1996 ACVR oral certification examination. Vet Radiol 1997; 38:156. 15. Miles KG: Basic principles and clinical applications of diagnostic ultrasonography. Comp Cont Educ Pract Vet 1989; 11:609. 16. Carrig CB, Mostosky UV: The use of compression in abdominal radiography of the dog and cat. Vet Radiol 1976; 17:57. 17. Zescov B, Petrociv B, Dragnovic B: Retropneumoperitoneal visualization of abdominal organs in domestic animals. Vet Radiol 1976; 17:23. 18. Gomez JA, Lawson TL, Korobkin M, et al: Selective abdominal angiography in the dog. Vet Radiol 1973; 14:72. 19. Farrow CS: Stress radiography. J Am Vet Med Assoc 1982; 181:777. 20. Barr F: Percutaneous biopsy of abdominal organs under ultrasound guidance. J Small Anim Pract 1995; 36:105. 21. Crystal MA, Penninck DG, Matz ME, et al: Use of an ultrasoundguided fine-needle aspiration biopsy and automated core biopsy for the diagnosis of gastrointestinal diseases in small animals. Vet Radiol Ultrasound 1993; 34:438. 22. Hager DA, Nyland TG, Fisher P: Ultrasound-guided biopsy of the canine liver, kidney and prostate. Vet Radiol 1985; 26:82. 23. Lamb CR, Trower ND, Gregory SP: Ultrasound-guided catheter biopsy of the lower urinary tract: technique and results in 12 dogs. J Small Anim Pract 1996; 37:413.
Chapter One Introduction 23 24. Leveille R, Partington BP, Biller DS, et al: Complications after ultrasound-guided biopsy of abdominal structures in dogs and cats: 246 cases (1984-1991). J Am Vet Med Assoc 1993; 203:413. 25. Smith S: Ultrasound-guided biopsy. Vet Clin North Am Small Anim Pract 1985; 15:1249. 26. Allen JK, Kramer RW: Enhanced sonographic visualization of biopsy needles. Vet Radiol 1993; 34:359. 27. Biller DS, Myer W: Ultrasound scanning of superficial structures using an ultrasound standoff pad. Vet Radiol 1988; 29:138. 28. Luerssen D: Presentation of percutaneous drainage of prostatic abscesses under sonographic control by means of two case reports. Kleinterpraxis 1993; 38:15. 29. Penninck DG, Finn-Bodner ST: Updates in interventional ultrasonography. Vet Clin North Am Small Anim Pract 1998; 28:1017. 30. Melany ML, Grant EG: Clinical experience with sonographic contrast agents. Semin Ultrasound CT MR 1997; 18:3. 31. Shapiro RS, Wagreich J, Parsons RB, et al: Tissue harmonic imaging sonography: an evaluation of image quality compared with conventional sonography. AJR Am J Roentgenol 1998; 171:1203. 32. Campani R, Bottinello O, Callida F, et al: The latest in ultrasound: three-dimensional imaging. Eur J Radiol 1998; 27:173. 33. Martinoli C, Derchi LE, Rizzatto G, et al: Power Doppler sonography: general principles, clinical applications and future prospects. Eur Radiol 1998; 8:1224. 34. Morgan JP, Silverman S: Techniques of veterinary radiography, ed 4. Iowa State Press, Ames, Iowa, 1987. 35. Ticer JW: Radiographic technique in veterinary practice, ed 2. WB Saunders, Philadelphia, 1984. 36. Kirberger RM: Radiograph quality evaluation for exposure variables—a review. Vet Radiol Ultrasound 1999; 40:320. 37. Papageorges M, Sande RD: The Mach phenomenon. Vet Radiol 1990; 31:274.
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A B C Fig. 2-63 A 10-year-old male
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Fig. 2-101 A 7-year-old male mixed
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Fig. 3-234 A 7-year-old female Brit
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Fig. 4-59 A 9-year-old female Russi
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Fig. 4-73 A 2-year-old female Saint
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Fig. 4-97 A 10-year-old male mixed
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Fig. 4-107 A 4-year-old male Chow C
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I N D E X A Abdomen, abnormal prese
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Index 729 Bone, cysts of, 525-527,
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Index 731 Ear, abscess of—cont’
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Index 733 Hydrocephalus—cont’d
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Index 735 Lungs. See also Pulmonary
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Index 737 Pregnancy, determination
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Index 739 S-shaped aortic deformity
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Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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