Ultrasound of the Urinary Bladder Wendy Blount, DVM Click on the blue arrow at bottom left or hit the “return” key to advance the show (mouse over to reveal) Free PowerPoint Templates

Patient Preparation Avoid urination for several hours prior to exam Don’t allow dogs outside Carry small dogs Remove litter box access for cats Place in dorsal recumbency Lateral recumbency for compromised patients Free PowerPoint Templates

Transition Adjustments Depth – varies according to size of pet and of bladder Frequency – higher – 6.5-7.5 MHz Try linear array probe if you have one Gain and Contrast – may need to decrease TGC – top levers left If you forget to do this, you might not visualize the ventral bladder wall very well Free PowerPoint Templates

Landmarks for Bladder Place probe on the caudal abdomen Start at the pubis and slide cranially until you find the bladder Use a light touch, if the bladder is small If you can’t find it, try rocking the probe caudally under the pubis, in case of pelvic bladder Or consider that it may be empty, or contain a tumor or clot, and may be isoechoic with abdominal contents Use a linear probe and turn harmonics on Free PowerPoint Templates

Image Views Sagittal Views (4) Transverse Views (3) Lateral, right Mid-Sagittal, cranial - apex Mid-Sagittal, caudal – trigone (2 distal ureters, proximal urethra), prostate Lateral, left Transverse Views (3) Cranial - apex Mid-Transverse Caudal Pole – trigone, prostate Bounce bladder to look for debris Free PowerPoint Templates

Image Views Sagittal Views (4) Transverse Views (3) Lateral, right Mid-Sagittal, cranial - apex Mid-Sagittal, caudal – trigone (2 distal ureters, proximal urethra), prostate Lateral, left Transverse Views (3) Cranial - apex Mid-Transverse Caudal Pole – trigone, prostate Bounce bladder to look for debris Free PowerPoint Templates

Bladder Wall Layers Outer Serosa – hyperechoic (white) Smooth Muscle Layers (3) – hypoechoic (black) Submucosa/Lamina Propria – hyperechoic (white) Mucosa – hypoechoic (black) May not always see the layers on ultrasound, without high frequency probe Free PowerPoint Templates

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Midline Apex

Scanning the Bladder Sagittal Views Mid (apex) Midline Apex

Scanning the Bladder Sagittal Views Midline Trigone

Scanning the Bladder Sagittal Views Midline Trigone

Scanning the Bladder Sagittal Views trigone Midline Trigone

Scanning the Bladder Sagittal Views Lateral Right

Scanning the Bladder Sagittal Views Lateral Right

Scanning the Bladder Sagittal Views Lateral Right

Scanning the Bladder Sagittal Views Lateral to the right Lateral Right

Scanning the Bladder Sagittal Views Lateral Left

Scanning the Bladder Sagittal Views Lateral Left

Scanning the Bladder Sagittal Views Lateral Left

Scanning the Bladder Sagittal Views Lateral Left

Scanning the Bladder Sagittal Views Lateral Left

Scanning the Bladder Lateral to the left Sagittal Views Lateral Left

Scanning the Bladder Transverse Views Cranial Apex

Scanning the Bladder Transverse Views Cranial Apex

Scanning the Bladder Transverse Views Cranial Apex

Scanning the Bladder Transverse Views Cranial Apex

Scanning the Bladder Cranial Transverse Views Cranial Apex

Scanning the Bladder Transverse Views Middle

Scanning the Bladder Transverse Views Middle

Scanning the Bladder Middle Transverse Views Middle

Scanning the Bladder Transverse Views Caudal Trigone

Scanning the Bladder Transverse Views Caudal Trigone

Scanning the Bladder Transverse Views Caudal Trigone Caudal Colon Acoustic shadow Caudal Trigone

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Colon artifact Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Sagittal – Neck of Bladder – Right to left Look for the “point” to make sure you go through midline Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Sagittal – Neck of Bladder – Right to left Look for the “point” to make sure you go through midline empty urinary bladder Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Sagittal – Neck of Bladder – Right to left Look for the “point” to make sure you go through midline A single sagittal video may be adequate for a small bladder – right to left Transverse – Cranial to caudal Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Sagittal – Neck of Bladder – Right to left Look for the “point” to make sure you go through midline A single sagittal video may be adequate for a small bladder – right to left Transverse – Cranial to caudal Too much pressure on probe – missing left side of the bladder Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Sagittal – Neck of Bladder – Right to left Look for the “point” to make sure you go through midline A single sagittal video may be adequate for a small bladder – right to left Transverse – Cranial to caudal Too much pressure on probe – missing neck of the bladder Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Sagittal – Neck of Bladder – Right to left Look for the “point” to make sure you go through midline A single sagittal video may be adequate for a small bladder – right to left Transverse – Cranial to caudal Gel deficiency Free PowerPoint Templates

Telemedicine Videos Sagittal – Cranial Bladder (Apex) – Right to Left Sagittal – Neck of Bladder – Right to left Look for the “point” to make sure you go through midline A single sagittal video may be adequate for a small bladder – right to left Transverse – Cranial to caudal Free PowerPoint Templates

Acknowledgments Stephanie Lisciandro, ACVIM (Internal Medicine) Chapter 6: Focused or COAST3 – Urinary Bladder Focused Ultrasound Techniques for the Small Animal Practitioner Editor Greg Lisciandro Bob Cole, ACVR Auburn University The Academy of Veterinary Imaging 2409 Avenue J, Suite C Arlington, TX 76006 (800) 268-5354

Acknowledgments John Mattoon, Danelle Auld, Thomas Nyland Chapter 4: Abdominal Ultrasound Scanning Techniques Small Animal Diagnostic Ultrasound Editors Nyland and Mattoon – 3rd Edition 2014 Thomas Nyland, John Mattoon, Eric Herrgesell. Erik Wisner Chapter 9: Urinary Tract Small Animal Diagnostic Ultrasound Editors Nyland and Mattoon – 3rd Edition 2014 John P. Graham, MVB, MSc, DVR, MRCVS Diplomate, ECVDI, Diplomate, ACVR Diagnostic Imaging in Dogs and Cats Nestle Purina – Clinical Handbook Series

Idexx Abdominal Ultrasound Scanning Protocol Acknowledgments Sara Hunt, LVT Idexx Abdominal Ultrasound Scanning Protocol