GP Vet Ultrasound

05/07/2024

Foreign body in the upper GI - proximal duodenum just past the pylorus.

05/07/2024

Happy Friday!
And of course it's Foreign Body Friday.
Old dog presented for vomiting 🤮 for 2 days. Blood💉💉 tests were unremarkable.
Radiographs 🩻 revealed a gas distended stomach and no obvious foreign body but scary looking duodenum dorsally. We were worried this was a GDV 😲😳

Ultrasound however revealed an upper GI Foreign body

Quick tip on scanning to find the pylorus of a gas filled stomach?

➡ Scan in right lateral recumbency with your probe underneath the patient. This eliminates the "dirty shadowing" you get with gas on ultrasound obscuring your view.

Patient went to surgery and a bone 🦴 was stuck at the proximal duodenum.

28/06/2024

28/06/2024

NEW WEEKLY POST- of the weird stuff our patients end up eating and how to find them on ultrasound.
Patient is a young cavoodle vomiting for 10 days on and off (!) 🤮 and just refusing to eat.
Clinically exam - Reasonably bright and alert, no obvious pain, nothing exciting on bloods or plain radiographs 🩻 Ultrasound showed a foreign body - in the jejunum.
Note this one DOES have the classic hyperechoic interface and distal acoustic shadowing of foreign material but notice on BOTH sides of the foreign body the intestinal wall is the same thickness and no fluid buildup noted oral to the foreign object.
This is a partial obstruction - fluid and gas can pass through.
What is the foreign body?
Check back tomorrow to find out 😎

24/06/2024

What is it about my ultrasound bag that cats love so much? 😎

Here is Buttercup enjoying sleep mode

24/04/2024

Reason I am running late for my next scan: clinic cat sleeping on my ultrasound case and of course I couldn’t disturb him!

19/01/2024

Gift from an awesome vet nurse 😍

29/12/2023

For any of my international followers who forget that December in the Southern Hemisphere is peak SUMMERTIME. 40 deg Celcius = 104F 🥵🥵

29/11/2023

Here is an old cat with a history of vomiting and weight loss. Blood tests were unremarkable.
Notice the stomach wall with complete obliteration of normal wall layering.
And at the end of the clip a scarily enlarged, rounded and hypoechoic gastic lymph node.
What is your most likely diagnosis in the this feline patient?

01/11/2023

Since I’m a mobile sonographer, there’s no doubt I do a LOT of driving and while I have my regular clinics and for the most part know my way around Brisbane.

I still need to use maps to give clinics some idea of my expected arrival time and of course to work out alternative routes if there’s an accident or higher than normal traffic. 🚗🚙🚘🚕🚔

I was very fond of Google maps but I’m finding that it’s started this annoying habit of sending me on wierd routes or adjust my route in the middle of driving because it thinks I’m in tariff when I’ve only been sitting at a traffic light for a minute or so.

Also! Google doesn’t know where I am if I’m in a tunnel so I inevitably miss my exit if I am using the ICB.

I am now using Apple Maps and it’s so much easier. I am alerted to change lanes way before I need to (which is so handy) and no wierd route changes.

What is everyone else’s experience. Do you use another navigation app? Apple or Google?

26/10/2023

Here is the video of the dog's bladder in my previous post. You can clearly see the tear in the bladder wall and thickening of the bladder wall on the left of the screen (cranial in the patient). This thickening may be due to inflammation directly from the tear or due to neoplasia.

26/10/2023

CASE OF THE WEEK!

Signalment: Adult Female Bull Mastiff x
History: Presented for lethargy, inappetance and painful abdomen. Bloods showed azotaemia.
Ultrasound findings: There was a large amount of free fluid mostly in the caudal abdomen. There was a swelling/thickening in the cranial bladder wall. On further investigation - a rent in the cranial wall was seen.
The free fluid was collected for a**lysis - creatinine levels were 10x higher than serum indicating the free abdominal fluid was likely to be urine. 😟
Diagnosis: Bladder rupture - likely from trauma but owners were adamant no history of trauma. ? Possible ruptured tumour.
Outcome: Patient was euthanised.

Can you see the point of rupture?

22/10/2023

Melbourne VetExpo 2023 DONE! Was so good to see such an interest in Veterinary Ultrasound in the GP Setting (standing room only 😎). Ultrasound is a skill that is most definitely in the GP Vet's wheelhouse. And I didn't mention an adrenal gland once! You don't need to find adrenal glands to be confident and skilled in ultrasound. Want to know more? Follow me for tips, tricks and interesting case studies.

21/10/2023

Gah! I’m sorry to those who saw my story when I had the wrong answer labelled as correct!!

17/10/2023

Who’s coming? 😊. See you there.

07/10/2023

Anyone attending the VetExpo? Come and say hello!

05/10/2023

Just 2 weeks left until The VET Expo 2023

🦜 Ignite your curiosity at The VET Expo, 18-19 Oct . Immerse yourself in a wealth of topics from animal welfare to dentistry. Join me and 2,500 fellow learners.

I'm speaking alongside 120 brilliant speakers including Diana Barker, President, AVA, Harry Cooper, Better Homes & Gardens and Jennie Hodgson, AVBC's Veterinary Schools Accreditation Advisory Committe (VSAAC) Co-Chair, Australasian Veterinary Boards Council.

Register here using my 30% discount code 'SNOBALL30' & earn up to 8 CPD points:
https://i.snoball.it/p/B1Br/f

THE VET EXPO IS WHERE THE ENTIRE VETERINARY, ANIMAL HEALTH AND PETCARE WORLDS COLLIDE

21/08/2023

Hello lovely vet ultrasonographers. I am speaking a the VetExpo in Melbourne, Australia about the use of ultrasound in the general practice setting and would love some help.

Do you have an interesting soft tissue ultrasound case that has helped a patient?

Foreign bodies, grass seeds, foxtails, thyroid tumours etc etc. I haven’t yet managed to find a foreign body in an abscess (it’s like my holy grail!) or a big thyroid mass.

I would love if you could send me some crazy, interesting and also boring images of patients that you have scanned.

Of course I will give full credit.

You can DM or email [email protected]

Any help you can provide is most appreciated.

27/06/2023

Case of the week!
This middle aged dog with a 7 day history of vomiting, inappetence and diarrhoea presented to the vet. No obvious pain and radiographs showed no evidence of a foreign body or obstruction.

Ultrasound demonstrated a very circular anechoic structure in the intestinal lumen. It looked like an eyeball 😳 There was a distinct obstructive pattern in scanning with dilated, fluid filled intestine one end of the structure and normal intestine on the other end. So while this did not fit the classic appearance of a foreign body (hyperechoic interface with a clean dropout distally), this patient was clearly obstructed. I was sure this was an orbie or something similar. Nature is certainly perfect but there isn't much apart from an eyeball that would be so perfectly spherical. Even cysts are never this perfect! Surgery was recommended.

Patient went to surgery and yes - a rubber ball with a jelly like substance was removed!

22/06/2023

The cryptorchid castration can make a usually simple and quick procedure frustrating for all involved.

❓Is it inguinal?
❓Is that a lymph node or a testicle?
❓Is that a fat pad or is that the testicle?
❓Is it just small and nearly there in the sc***um?
❓Am I going to have to go searching in the abdomen for over an hour only to discover that it's actually inguinal and my patient went through unnecessary surgery, my nurse is getting annoyed because I have a greyhound bitch spey and 3 dentals still to do and an afternoon full of consults.
❓Am I going to have to miss out on lunch AGAIN?

😔

1️⃣ Start with a linear probe if you have one
2️⃣ Look at the scrotal testicle with the probe so you know what you're looking for
3️⃣ Determine if the retained testicle is right or left
4️⃣ Start at the sc***um and move inguinally
5️⃣ Then move to the abdomen and while moving your probe cranially, stay in longitudinal plane and laterally from the midline.
6️⃣ If you see the kidney you've gone too far cranially.

Ultrasound can be such a helpful tool in searching for a retained testicles:
The beauty of te**es on ultrasound is that there are (usually) unmistakeable!:
They are often hyperechoic with a smooth echotexture in the adult entire male but in younger dogs may appear hypoechoic. Look for the mediastinum te**is, which is a hyperechoic linear structure within the centre of the testicle. This is much more easily seen when the te**es is imaged in the sagittal plane.

✅ Once you know where to make your incision, you can be confident the surgery will not go overtime, your patient will not have to endure multiple unnecessary incisions and recovery time will be much quicker.

✅ I have clinics who routinely use me to find the retained testicles to improve patient outcomes and for hospital efficiency.

15/06/2023

All I'm seeing are sad cases lately 😔
Here is a 4 year old retriever with significant weight loss and palpable mass in the abdomen.
He had a large mass likely arising from the right kidney ‼️ Note the hydronephrotic appearance of the kidney in transverse plane.
Not only that but similar looking masses were noted throughout the lymph nodes and particularly the medial iliac nodes. Re**al examination - a**l gland were normal and empty.
It just got worse and worse as I continued scanning. Masses were also noted within the vena cava causing turbulent flow (the video I post on Sunday)
Examination of the chest showed nodular lesions in the lungs. 🥺
Samples of the mass, MILN as well as the lung nodule were collected:
Diagnosis for both mass and lung nodule:
Carcinoma. Unknown origin.
😔

11/06/2023

Turbulent flow in the vena cava. Likely from a tumour that has invaded into the vena cava. This is a really sad case in a 4 year old retriever :(

05/06/2023

When you turn on your ultrasound machine and get ready to scan but you see this wave like pattern on the screen - do not panic!

This is electrial interference ⚡️⚡️⚡️⚡️and it's caused by exactly that: interference from other electrial equipment too close. If this happens, turn all other electical equipment off and see if the problem disappears.

01/06/2023

Case of the week! Here's one you can pretty much diagnose on history alone but it's so good to see ultrasound pics for confirmation!

10 yr old FE Retriever just had a season about 5 weeks ago, has become lethargic over the past couple of days and is drinking a ton of water.

Ultrasound images immediately confirm the diagnosis of pyometra: Tortuous uterine horns filled with flocculant fluid and thickened and irregular wall. Differentials would be mucometra, haemorrhage but these are less likely given her history.

Check out the difference in echogenicity of the anechoic (black) urine in the bladder & the grainy and grey uterus. The closed cervix is also noted just under the bladder!

And for those surgeons out there, I haven't forgotten about you - at the end are some gross pyo pics for your viewing pleasure.

For my non-vet readers: Pyometra is a serious condition where pus fills the uterus. This an be life-threatening and treatment involves fluid therapy, antibiotics and surgery as soon as possible once the patient is stable enough for an anaesthetic to remove the uterus. Pet owners can prevent this by desexing their female dogs as soon as they reach maturity.

04/05/2023

CASE OF THE WEEK!
Gallbladder halo sign - my absolute pet peeve is when vets automatically assume that gallbladder oedema is anaphylaxis anaphylaxis anaphylaxis. Yes, ONE of the differential diagnoses for the halo sign is acute allergic reaction/anaphylaxis but there are so many other causes.
✅Here's a 12 year old Husky x that presented for lethargy and vomiting approx 3 day duration
✅Abdominal ultrasound - showed the gallbladder halo - the gall bladder wall is usually thin and hyperechoic; gallbladder halo or gallbladder wall oedema shows a hypo or anechoic band between hyperechoic lines of the wall.
✅ Differentials for GB halo include: right sided heart failure, cholecystitis, pericardial effusion, volume overload and of course anaphylaxis
✅ In this patient - he had a very large right adrenal tumour with irregular margins and with vascular invasion into the caudal vena cava. 😱This likely caused reduced venous return and subsequent gallbladder wall oedema.

⚠️ Take home message - do not assume that the halo means anaphylaxis. Ensure you have thoroughly examined the whole abdomen for all possible differential diagnoses

30/04/2023

I've been out of action lately: my pregnant foster queen has given birth to SEVEN kittens 😳(and I promise to keep you updated with pics of them and the proud mum too)
We're back to case of the week!
History:
1️⃣ Middle aged cattle dog with weight loss, lethargy and vomiting
2️⃣ Bloods - unremarkable except for mild non-regenerative anaemia
3️⃣ Abdominal ultrasound performed: focal thickening of the stomach wall with complete obliteration of wall layering. A large hypoechoic gastric lymph node was also noted 😞
⚠️ Malignant gastric tumours include:
adenocarcinoma -
leiomyosarcoma
lymphoma
Biopsy is necessary for definitive diagnosis.

30/03/2023

Another diagnostic challenge! Sometimes we are presented with a patient with a vague history of being unwell & a growing abdomen. On palpation, patient has a large, tight abdomen, possibly a swelling on one side. Bloods are unremarkable. Abdominal ultrasound shows a very LARGE mass taking up most of the abdomen and obscuring all other organs 😳‼️

Sonographer's challenge is to determine from which organ the mass originates .The trick is to manoeuvre the probe in as many different angles and planes as possible. Look for any normal tissue and find connection between normal and abnormal tissue

Here is a teeny tiny chihuahua with a very large tumour with a small amount of free fluid. There is connection between normal splenic tissue and the mass, making this tumour a splenic one. The liver appeared normal on ultrasound.

Surgery - removed a tumour almost as large as the patient and from all accounts patient is doing well. 😀💜

23/03/2023

I've spoken about my love for clinic cats but I'm also very blessed to visit a clinic that has their very own Clinic Dog! 🐶 Meet Buddy from The Glen Veterinary Surgery At The Gap .

Buddy is everything you can wish for in a colleague - he's always happy to see you. He does his utmost to please and he will happily take payment in the form of pats, hugs and yoghurt drop treats. Here he is with his boss, Dr Renae; such a good employee standing to attention!

While clinic cats can be moody and judgemental, clinic dogs always look on the bright side and are just happy to be in your presence. We should all be a little more like Buddy