1. Ultrasound of Thorax & Peripheral Tissues
Wendy Blount, DVM ~ Brian Huber, DVM, ABVP
June
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2. Indications for Thoracic Ultrasound
Pleural fluid masks lesions on radiographs, but provides an acoustic window for ultrasound
Tachypnea, dyspnea
Pleural rubs on auscultation, pleural fluid on tap or radiograph
TFAST3 – Thoracic Focused ASsessment for Trauma
Rapid detection of pneumothorax or thoracic effusion
Most preventative cause of death in traumatized people
Assessment for injury in pleural and pericardial spaces, thoracic wall and lungs
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3. Indications for Thoracic Ultrasound
VetBLUE –Bedside Lung Ultrasound Exam
TFAST3 and VetBLUE – should be done together
Used together to assess respiratory distress
Characterize lung conditions as upper vs. lower airway
Or lung vs. third space (pleural, pericardial)
Or respiratory vs. systemic
Systemic = fever, hemoabdomen, metabolic acidosis, hypoetension, etc.
TFAST3 and VetBLUE and TFAST3
emergency assessment
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4. Indications for Thoracic Ultrasound
TFAST3 cannot
Characterize pleural or pericardial fluid
Fully replace thoracic rads
Diagnose systemic causes of respiratory distress
Caveat – cannot interrogate deep lung tissue if peripheral lung tissue is well ventilated
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5. Indications for Thoracic Ultrasound
Ultrasound is the modern stethoscope
More sensitive than PE for types of thoracic disease
More sensitive than chest rads for
peripheral pulmonary edema
Pleural effusion, pericardial effusion
Peripheral lung consolidation (contusion, pneumonia, edema)
Characterizing severity of lung consolidation
Caveat – cannot interrogate deep lung tissue if peripheral lung tissue is well ventilated
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6. Patient Preparation Sternal recumbency
May need to sedate with ace-buprenorphine for lung aspiration if tachypneic
No sedation needed for thoracocentesis in most cases
Sedation of cats with pleural effusion can be deadly
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7. Image Views intercostal Parasternal (echo views)
Thoracic inlet (cranial mediastinum)
Subcostal (abdominal)
TFAST3 and VetBLUE
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8. Goals – Thoracic Ultrasound
Characterize pleural fluid, and determine cause
Evaluate for masses in mediastinum
Evaluate for pulmonary edema and pulmonary metastasis
Assess integrity of the diaphragm
Aspirate lung lesions or diffuse lung disease
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9. TFAST3
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10. Vet BLUE
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11. Vet BLUE TFAST3
Gator Sign
normal lung
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12. TFAST3 Lung Rockets (B lines)
Air bronchograms – lung consolidation (wet lung)
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13. TFAST3
Nodule Sign
Soft Tissue Mass at the pleural surface – fluid density within air
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14. TFAST3
Tissue Sign
Lung consolidation without aeration (hepatized lung)
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15. TFAST3
Shred Sign
partial lung consolidation – with some aeration of lung
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16. TFAST3 Step Sign – disruption of the normal pleural line
DDx – pleural effusion, thoracic wall trauma
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17. TFAST3 Glide Sign, with A lines
To and fro motion of the lungs along the thoracic wall
Rules out pneumothorax (negative pressure in pleural space)
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18. TFAST3 A Lines without glide sign Pneumothorax
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19. TFAST3
Subcutaneous Emphysema
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20. Acknowledgments Robert Fulton
Chapter 8: Focused or COAST3 – Reproductive Focused Ultrasound Techniques for the Small Animal Practitioner Editor Greg Lisciandro

21. 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 12: Ovaries and Uterus Small Animal Diagnostic Ultrasound Editors Nyland and Mattoon – 3rd Edition 2014