Free PowerPoint Templates Ultrasound of the Reproductive Tracts Wendy Blount, DVM

Female: Acute abdomen Acute abdomen Fever, sepsis, abnormal WBC (pyometra) Fever, sepsis, abnormal WBC (pyometra) Hematuria, dysuria Hematuria, dysuria Vulvar discharge Vulvar discharge Ovarian remnant syndrome Ovarian remnant syndrome Pregnancy confirmation, rough staging Pregnancy confirmation, rough staging Evaluation of dystocia – assess fetal distress or death Evaluation of dystocia – assess fetal distress or death Monitor medical management of pyometra Monitor medical management of pyometra Free PowerPoint Templates Indications for Repro Ultrasound

Male: Enlarged prostate on rectal exam or abdominal palpation Enlarged prostate on rectal exam or abdominal palpation Acute abdomen Acute abdomen Fever, sepsis, abnormal WBC (prostatitis) Fever, sepsis, abnormal WBC (prostatitis) Hematuria, dysuria, tenesmus, penile discharge Hematuria, dysuria, tenesmus, penile discharge Rear limb lameness Rear limb lameness Cryptorchidism – to plan surgery Cryptorchidism – to plan surgery Scrotal swelling Scrotal swelling Testicular enlargement Testicular enlargement Free PowerPoint Templates Indications for Repro Ultrasound

Look for a tattoo Look for a tattoo Green line parallel to the incision Green line parallel to the incision Left ear tip on the cat (1 cm) Left ear tip on the cat (1 cm) Scan for a microchip and check information online Scan for a microchip and check information online Penile spines on the male cat indicate an intact male Penile spines on the male cat indicate an intact male Ultrasound!!!! Ultrasound!!!! Speutered pets have been known to retain their parts Speutered pets have been known to retain their parts Free PowerPoint Templates Is the Pet Speutered?

Free PowerPoint Templates Is the Pet Speutered? Look for a tattoo Look for a tattoo Green line parallel to the incision Green line parallel to the incision Left ear tip on the cat (1 cm) Left ear tip on the cat (1 cm) Scan for a microchip and check information online Scan for a microchip and check information online Penile spines on the male cat indicate an intact male Penile spines on the male cat indicate an intact male Ultrasound!!!! Ultrasound!!!! Speutered pets have been known to retain their parts Speutered pets have been known to retain their parts intact male neutered male

Free PowerPoint Templates Is the Pet Speutered? link

Free PowerPoint Templates Patient Preparation Fast for 12 hours Fast for 12 hours Urine filled bladder provides acoustic window Urine filled bladder provides acoustic window Place in dorsal recumbency Place in dorsal recumbency Lateral recumbency for: Lateral recumbency for: Compromised or deep chested patients Compromised or deep chested patients Standing/sternal may be necessary for patients with large abdominal masses Standing/sternal may be necessary for patients with large abdominal masses

Free PowerPoint Templates Transition Adjustments Depth – usually no changes from abdominal presets Depth – usually no changes from abdominal presets Frequency – varies MHz Frequency – varies MHz May need higher frequency for smaller pets May need higher frequency for smaller pets For the best detail, the highest frequency that will penetrate to the adrenals should be used For the best detail, the highest frequency that will penetrate to the adrenals should be used Gain and Contrast – may need to increase gain when moving from bladder to prostate Gain and Contrast – may need to increase gain when moving from bladder to prostate TGC – adjust as needed TGC – adjust as needed

Free PowerPoint Templates Landmarks for Repro Ultrasound Uterus – begin ventral to the bladder - find body between urinary bladder and colon, near midline Looks like gut but smaller Looks like gut but smaller Follow each uterine horn to its ovary Follow each uterine horn to its ovary Ovaries - at the caudal poles of the kidneys, up to 2cm caudal Prostate - caudal to the bladder, surrounding proximal urethra Cryptorchid Testicles Abdominal - as far cranially as the caudal kidney pole, as far caudally as the internal inguinal ring Abdominal - as far cranially as the caudal kidney pole, as far caudally as the internal inguinal ring or in the inguinal canal or in the inguinal canal

Free PowerPoint Templates Image Views Uterine Body (2) - at urinary bladder 1.Long Axis (sagittal) 2.Short Axis (transverse) Ovaries (1-2 each) 1.Long Axis (sagittal) 2.Short Axis (transverse) if enlarged Prostate (2) 1.Long Axis (sagittal) 2.Short Axis (transverse ) 3.Trans-rectal? Testicles (2 each) 1.Long Axis (sagittal) 2.Short Axis (transverse)

Free PowerPoint Templates Image Views Uterine Body (2) - at urinary bladder 1.Long Axis (sagittal) 2.Short Axis (transverse) Ovaries (1-2 each) 1.Long Axis (sagittal) 2.Short Axis (transverse) if enlarged Prostate (2) 1.Long Axis (sagittal) 2.Short Axis (transverse ) Testicles (2 each) 1.Long Axis (sagittal) 2.Short Axis (transverse)

Identify masses in ovaries, uterus, prostate or testicles Identify masses in ovaries, uterus, prostate or testicles Identify abnormal uterine fluid Identify abnormal uterine fluid Assess dystocia for surgery Assess dystocia for surgery Identify ovaries in ovarian remnant syndrome Identify ovaries in ovarian remnant syndrome Identify testicles in cryptorchidism Identify testicles in cryptorchidism Locate and FNA testicular tumors Locate and FNA testicular tumors Assess for BPH, prostatitis Assess for BPH, prostatitis Identify periprostatic cysts Identify periprostatic cysts Free PowerPoint Templates Goals – Repro Ultrasound

Any distending uterine fluid is abnormal Any distending uterine fluid is abnormal Anestrus uterus has no detectable lumenal contents Anestrus uterus has no detectable lumenal contents Estrus uterus has thin white lumenal line like gut Estrus uterus has thin white lumenal line like gut Normal canine uterus <1cm in width Normal canine uterus <1cm in width If you have trouble tracing the uterine horns, they are probably not clinically relevant If you have trouble tracing the uterine horns, they are probably not clinically relevant Uterine atresia is rare (unilateral or bilateral) Uterine atresia is rare (unilateral or bilateral) Ipsilateral ovary is usually present Ipsilateral ovary is usually present Ovaries larger than 3cm are likely neoplastic Ovaries larger than 3cm are likely neoplastic Free PowerPoint Templates Tips – Repro Ultrasound

Uterine involution should be complete by 3-4 weeks post-partum Uterine involution should be complete by 3-4 weeks post-partum Uterus up to 3-5 cm in diameter immediately post-partum Uterus up to 3-5 cm in diameter immediately post-partum Uterus <1cm in diameter when involuted Uterus <1cm in diameter when involuted Quantitating prostate size Quantitating prostate size Diameter < ½ - 2/3 width of pelvic inlet on VD pelvis radiograph Diameter < ½ - 2/3 width of pelvic inlet on VD pelvis radiograph Free PowerPoint Templates Tips – Repro Ultrasound

Whelping is days after the LH surge Whelping is days after the LH surge Free PowerPoint Templates Tips – Gestational Age Radiographic Gestation Age Days After LH Surge Structuremeanrange Spherical uterine swellings Ovoid uterine swellings First evidence of skull mineralization Scapula, humerus, and femur mineralized Radius, ulna and tibia mineralized Pelvis and all ribs mineralized Coccygeal vertebrae, fibula, calcaneus, and distal extremities mineralized

Whelping is days after the LH surge Whelping is days after the LH surge Free PowerPoint Templates Tips – Gestational Age Sonographic Gestation Age – Fetal Feature Days After LH Surge Enlarged uterus (corrugated)4-14 Gestational sac (don’t blink – you’ll miss it)14-20 Embryo, Heartbeat best time to estimate fetal number23-25 Can tell head from tail (fetal poles)25-29 Skeleton, Stomach, Urinary Bladder, Limb buds, fetal movement30-39 Cardiac Chambers (fetal viability)38-40 Lung hyperechoic vs. liver38-42 Liver hyperechoic vs. abdomen, Kidney, Eyes39-47 Intestinal motility57-63

Estimating gestation age (GA) GSD = gestational sac diameter GSD = gestational sac diameter CRL = crown to rump length CRL = crown to rump length Calculating age <40 days + 3 days GA = (6 X GSD) + 20 GA = (3 X CRL) + 27 Free PowerPoint Templates Tips – Gestational Age

Estimating gestation age (GA) GSD = gestational sac diameter GSD = gestational sac diameter CRL = crown to rump length CRL = crown to rump length Calculating age <40 days + 3 days GA = (6 X GSD) + 20 GA = (3 X CRL) + 27 Free PowerPoint Templates Tips – Gestational Age Gestation Sac Diameter (GSD) Crown to Rump Length (CRL) Head Diameter (HD) Body Diameter (BD)

Estimating gestational age after 40 days is difficult Estimating gestational age after 40 days is difficult Exponential growth takes off at 40 days Exponential growth takes off at 40 days Growth rates vary by breed size Growth rates vary by breed size GSD becomes oval & difficult to measure accurately GSD becomes oval & difficult to measure accurately CRL becomes more difficult to measure CRL becomes more difficult to measure Body diameter (BD) exceeds Head diameter (HD) by more than 2mm at about 40 days Body diameter (BD) exceeds Head diameter (HD) by more than 2mm at about 40 days CRL exceeds placental length at about 40 days CRL exceeds placental length at about 40 days There are methods using HD to approximate age after 40 days There are methods using HD to approximate age after 40 days Free PowerPoint Templates Tips – Gestational Age

Cannot distinguish pyometra, hydrometra, mucometra Cannot distinguish pyometra, hydrometra, mucometra Pyometra fluid can by anechoic to hyperechoic Pyometra fluid can by anechoic to hyperechoic Segmental pyometra is possible – may need FNA Segmental pyometra is possible – may need FNA Cannot provide accurate fetal count Rads after 45 days are better, but not perfect Make sure patient is fasted Cannot always evaluate every fetus for distress/death Synbiotics Relaxin Test Earliest test at 21 days post LH surge Confirms conception, not pregnancy – presence of placenta Free PowerPoint Templates Pitfalls – Repro Ultrasound - Female

FNA of fluid filled uterus is not recommended FNA of fluid filled uterus is not recommended Risks rupture & peritonitis if pyometra Risks rupture & peritonitis if pyometra Free PowerPoint Templates Pitfalls – Repro Ultrasound - Female

May not be able to access for ultrasound the prostate in a neutered dog May not be able to access for ultrasound the prostate in a neutered dog Full bladder can help pull the prostate cranially Full bladder can help pull the prostate cranially Free PowerPoint Templates Pitfalls – Repro Ultrasound - Male

Summary PowerPoints – Ultrasound of the Reproductive Tract, Repro CasesUltrasound of the Reproductive TractRepro Cases.pdf of PowerPoint – Ultrasound of the Reproductive Tract, Repro Cases.Ultrasound of the Reproductive TractRepro Cases Prostate Ultrasound TIPs Sheet Animated PowerPoints – Scanning the Reproductive Tracts – male and femalemalefemale

Acknowledgments Robert Fulton Chapter 8: Focused or COAST 3 – Reproductive Focused Ultrasound Techniques for the Small Animal Practitioner Editor Greg Lisciandro John P. Graham, MVB, MSc, DVR, MRCVS Diplomate, ECVDI, Diplomate, ACVR Diplomate, ECVDI, Diplomate, ACVR Diagnostic Imaging in Dogs and Cats Nestle Purina – Clinical Handbook Series Kathy Spaulding, DVM, DACVR Sonographic Evaluation of the Female Reproductive Tract Atlantic Coast Veterinary Conference, 2013

Acknowledgments John Mattoon, Danelle Auld, Thomas Nyland Chapter 4: Abdominal Ultrasound Scanning Techniques Small Animal Diagnostic Ultrasound Editors Nyland and Mattoon – 3 rd Edition 2014 Thomas Nyland, John Mattoon, Eric Herrgesell, Erik Wisner Chapter 12: Ovaries and Uterus Small Animal Diagnostic Ultrasound Editors Nyland and Mattoon – 3 rd Edition 2014 Joann Randall, DVM, DACVT Gestational Aging Veterinary Information Network – Associate

Acknowledgments John Mattoon, Thomas Nyland Chapter 13: Prostate and Testes Small Animal Diagnostic Ultrasound Editors Nyland and Mattoon – 3 rd Edition 2014