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UsTogether

As a mobile vet ultrasonography we travel to your pet to run diagnostic scans at your vet and pregnancy diagnosis at your own home
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10/04/2023

How do you tell whether something on the bladder wall is a mass or a blood clot? Doppler! Here's a bladder mass protruding into the lumen, and with Doppler interrogation you can see there is blood flow into the mass making a simple blood clot much less likely.
In this case the dog had presented with occasional haematuria and toileting mishaps. There was no evidence of metastasis and surgery was recommended.

See what you're missing with ultrasound.
Complete diagnosis and care with Us Together.

05/04/2023

Halo sign on a gall bladder- often this is seen in the emergency room when dogs are having an anaphylactic shock, but in this case the gall bladder wall was oedematous for a different reason- can you spot the enhanced liver vasculature? It's because the liver is hypoechoic. Aspirates of the liver confirmed intermediate to large cell lymphoma in this dog that had simply been off food and vomiting.
See what you're missing with ultrasound!
Complete diagnosis and care with Us Together.

24/02/2023

This cat presented with a suspected early blocked bladder, and was scanned for a quick assessment but I thought these images were fun and worth sharing! The urethra was enlarged for the first 2-3cm, which you can see on the first picture as a black tube coming down from the bladder on the left. If you look closely on the right side the tube ends with a white line. The second photo is applying Doppler on the white line and seeing a strong twinkle artifact, which is often seen with crystals, and confirms the suspicion that this poor cat was totally blocked up with crystals in his urethra!

Complete diagnosis and care with Us Together.

13/12/2022

Us Together are closing over the Christmas holidays, our last day will be the 20th December. If you have any patients that need a scan prior to this please book quickly as places are filling fast!
For all your ultrasound needs including fine needle aspiration and cardiac mensuration we'll be back after Australia Day, and as always you can book directly through our portal on the website www.ustogether.com.au.
Have a very jolly Christmas from Us Together.

07/11/2022

In this video you can see the large adrenal mass has a soft tissue segment that descends down the phrenicoabdominal vein into the caudal vena cava. Sadly this has a very direct impact on prognosis due to high perioperative mortality, and palliation is often chosen.

At Us Together we routinely scan the whole abdomen to look for abnormalities, not just the organ of interest. In this case we'd been asked to image the liver but found this mass as part of a thorough examination.
Complete diagnosis and care with Us Together.

16/09/2022

We recently scanned a patient showing urinary problems and diagnosed severe pyelonephritis (see photo). A study by Perry et al(1) found that 50% of patients with urosepsis had a pyelonephritis as their focus of infection (which was almost double the rate of pyometra as a cause of sepsis!!). Which means that if you're not scanning those kidneys in your patients with suspected urosepsis, you're potentially missing half of them. Ultrasound is simply the best way to diagnose these patients, and remember- we come to you to help make the diagnosis.

1. Perry et al, Clinical features, outcome and illness severity scoring in 32 dogs with urosepsis 2017-2018 Journal of Veterinary Emergency and Critical Care, 32:2, March/April 2022, 236-242.

12/08/2022

What to do when you find this?! Here's a kidney showing medullary rim sign, a common finding when scanning kidneys. There is a hyperechoic ring which is below the corticomedullary junction as seen by the hypoechoic halo around it. But what does it mean?
Medullary rim sign can be associated with tubular inflammation eg FIP, acute tubular necrosis, chronic interstitial nephritis. But it is also commonly seen in normal pets too! 72% of dogs with only medullary rim sign did not have any renal dysfunction.
Takeaway message:- if there is other signs of renal disease present eg small kidneys or pyelectasia, then renal disease is suspected. If it is the only abnormality detected it is more likely to be incidental- urinalysis is still an easy worthwhile test to rule out dysfunction.
In this case the cat had an ascending pyelonephritis, which was managed after culture and sensitivity testing.
Complete diagnosis and care with Us Together.

Ref:- Mantis P, Lamb CR. Most dogs with medullary rim sign on ultrasonography have no demonstrable renal dysfunction. Vet Radiol Ultrasound 2000;41:164-166.

29/07/2022

With huge thanks to all the clinics that we support we are proud to announce that July was a record-breaking month for scans around Melbourne!
All sorts of foreign bodies, many neoplasms sadly, ureteroliths, pyelonephritis, cholecystitis, and many more all diagnosed in the comfort of your clinic.
Find out what you're missing with Us Together- scanning but simpler.

28/07/2022

Two foreign body cases with a second problem!
Co-morbidities are frequently encountered when performing a proper abdominal ultrasound.
In these cases both patients had eaten something daft leading to the ultrasound (which is more sensitive than xrays for blockages), but the first dog also had a splenic mass and the cat also had markedly enlarged muscularis throughout its gut not associated with the foreign body.
Both ended up in surgery to address both their issues with the surgeon fully briefed, no surprises!
Complete diagnosis and care with Us Together.

03/06/2022

Yesterday we showed a video of a descending duodenum which was moderately dilated with fluid but showed peristaltic waves. Aborally from this distended duodenum was an irregular-shaped object causing distal acoustic shadowing. The hypoechoic mucosa was visualised going over the surface of the object which made it likely intraluminal. Distal to this object there was a great example of reverberation artifact caused by gas, which can sometimes be confused for a foreign body (see previous post as it's a great side-by-side example)
The object was of course a foreign body which was promptly removed- see how well the object fits with the outline on the ultrasound!!
This kitten had inconclusive xrays prior to ultrasound- showing the superior power of ultrasound to detect foreign bodies.
Remove the unknown from your daily work and consider an ultrasound with Us Together for those vomiting cases.

02/06/2022

To cut or not to cut?
Here's a great video of a descending duodenum from a vomiting kitten. The serosal-serosal diameter at the start of the video is 7.5mm. The stomach was moderately dilated given the 2 day duration of anorexia.
How would you proceed in this case? Please write in the comment section below!
The answer will be posted tomorrow.

25/05/2022

Ultrasound can also be used to look for different things than just organs. It is especially useful in those recurring neck abscesses which can both identify a migrating grass seed but can also direct the forceps to remove the foreign object in real-time through a key-hole incision.
In this case, an umbilical hernia was confirmed on ultrasound- you can see the hyperechoic muscle terminate either side of the hernia, with a small amount of anechoic fluid and adipose tissue connecting the abdomen with the subcutaneous space. The hernia was firm and irregular to touch so ruling out a mass lesion was important prior to surgical correction.
Complete diagnosis and care with Us Together.

17/05/2022

Are you missing 1 in 5 cases of hyperA?
Adrenal tumours account for 20% of hyperadrenocorticism in dogs (Behrend, in Canine and Feline Endocrinology 2015), so 1 in 5 may be better suited to surgical intervention than medical therapy. Ultrasound is a great way to help differentiate PDH vs ADH and may completely change the way a patient is managed, and should be considered in EVERY case of hyperadrenocorticism diagnosed by blood testing.
Us Together regularly image adrenal glands for asymmetry and enlargement to help the best clinicians with managing hyperA cases.
Complete diagnosis and care with Us Together.

09/05/2022

At the ready for emergency scans!
In the past couple of weeks we've seen pericardial effusions, haemoperitoneum and ascites, pleural effusions, HCM cats, intussusceptions...
Don't forget we are available for emergency scans as well as routine ones, helpful for those urgent cases that don't give you much on in-house diagnostics (none of the above were able to be diagnosed by xray alone). Our mobile service gives a wider range of diagnostic options to the clinician at the push of a button and means you can get a rapid answer without having to organise an emergency referral, saving your client time and money.
Complete diagnosis and care with Us Together.

29/04/2022

Shortly after posting about incidental renal cysts, here was a cat with pathological ones- polycystic kidney disease. With 5 cysts in both kidneys and a hepatic cyst (which has been reported in concurrence), this is diagnostic for PKD. The cat did not have any changes on bloods at this stage, but kidney function will likely deteriorate over the next couple of years.
This was found during a routine scan for another disease process, showing the importance of scanning the whole abdomen and not focusing on the obvious pathology.
At Us Together we routinely scan the entire abdomen and often find more than one change in a single patient.
Complete diagnosis and care with Us Together.

19/04/2022

HAPPY BIRTHDAY to my M8!!
It's been a year, we've travelled all around Melbourne, scanned well over a hundred patients in over a dozen clinics and diagnosed some really cool things together. We've left no bladder stone unturned in what has been a tricky year with lockdowns and home teaching.
The M8 continues to give fantastic pictures which greatly assist the clinicians' repertoire and ability to diagnose pathology that otherwise would be missed.
Here's looking forward to an even busier year of complete diagnosis and care with Us Together.

08/04/2022

Cyst erm.. overload?
When scanning older dogs' kidneys it is not uncommon to find the occasional small cyst. These are often small, 1-3mm in size. They have a fairly classic appearance with a thin wall, anechoic content, distal acoustic enhancement (as seen in this picture with the whiter section below the cyst). It is often related to renal ageing and chronic renal failure so the kidneys may also show other signs of degeneration and blood testing is recommended, but the cysts themselves are essentially incidental in this scenario and do not warrant any treatment unless causing issues with the collecting system.
In cats it's a different story, especially with long-haired domestics or Persians who carry an autosomal dominant gene that causes polycystic kidney disease. Whilst gene testing is available to detect PKD, gene testing doesn't dictate severity and the gene test doesn't cover all mutations. As a result a general guide is used to predict the disease ultrasonographically:- PKD likely if at least one cyst is present in cats under 15 months of age, 2 or more cysts from 16-32 months, 3 or more 33-49 months, 4 or more if older.
Inherited polycystic disease is also described in Cairns Terriers and Bull Terriers, so don't assume just because it doesn't meow it can't be PKD!
At Us Together we routinely scan both kidneys as part of our diagnostic work-up and often detect incidental cysts on our older patients, as well as pyelonephritis and renal tumours, all of which are very difficult to diagnose without ultrasound.
Complete diagnosis and care with Us Together.

01/04/2022

Ever seen a "face" in an ultrasound scan?
It's called face pareidolia. According to research it is much more common to see male faces in everyday objects. The brain works in funny ways...
Here's one from a scan recently. I'm clearly cheating as it really is a puppy's head!
You can read more about face pareidolia in this article on the ABC:-
https://www.abc.net.au/news/2022-01-30/illusory-faces-usually-male-research-shows-face-pareidolia/100787180

25/03/2022

Staying with the urinary theme, here's a picture of a bladder trigone with a marked acoustic shadow- it's a urolith right? Straight to surgery to remove?...
There is also a marked thickening of the bladder wall all around it, so it may not be quite so simple and shows the importance of taking in the whole scan rather than focussing on the obvious shadowy bit.
Cytology confirmed the suspicion of a urothelial carcinoma, aka transitional cell carcinoma. The acoustic shadow is likely an area of mineralisation within the tumour.

Complete diagnosis with Us Together. Scanning but simpler.

18/03/2022

How would you approach this case?
A 15 year-old cat with recurring cystitis was scanned to evaluate why her infections keep returning. Classically we look for bladder or kidney stones, signs of polyps or tumours that may have become infected, etc.
In this case the left kidney was found to have a markedly dilated renal pelvis measuring 11mm across, whereas the right kidney had a more normal pelvis (but can you name the change that suggests not all is well?)
The bladder had a focal homogeneous thickening measuring 3.1mm at the area where the ureter inserts. There were no uroliths evident in the ureter, kidney nor bladder.
How would you proceed in this case?
Renal pelvii can measure up to 3.2mm in normal cats. A measurement of 11mm makes diuresis or acute/chronic renal insufficiency less likely, and leaves pyelonephritis or outflow obstruction as possible causes. In this case there was a thickening of the bladder at the ureteral insertion site, which may be causing unilateral obstruction, but we need to clarify the cause.
As always, aspiration and cytology is key! In this case the bladder thickening was aspirated and found to contain dysplastic and inflammatory change with the occasional rod present. The renal pelvis itself was aspirated and C&S confirmed a massive rod pyelonephritis and appropriately sensitive antibiotics was started before the kidneys shut down completely.

Complete diagnosis and care with Us Together.

04/03/2022

The secret to telling what a mass is during an ultrasound-
When you see a mass on ultrasound, can you diagnose it there and then?
The truth is a lot of the time you can't. Without cytology in most cases it is impossible to make a diagnosis other than there's a disruption to the normal size and shape of an organ. Here's a selection of liver masses detected on ultrasound, can you tell which one is an abscess vs a tumour? (hint:- only one is a hepatocellular carcinoma, the rest are hepatic abscesses diagnosed through aspirates)
Don't make assumptions with ultrasound, not everything is cancer!
At Us Together we routinely aspirate lesions to help identify the underlying pathology- complete and accurate diagnosis and care for your patients.

25/02/2022

Wasn't expecting this...
What do you do when you find an incidental adrenal mass?
This adrenal mass was found as an incidental finding on a dog with unrelated GIT issues. Incidental adrenal masses are found in up to 4% of abdominal scans, highlighting the importance of performing full abdominal scans. Aspirates can be risky if it's a pheochromocytoma, so what do you do now?
The size can give us an indication- masses over 2cm are more likely to be neoplastic (as in this case). Invasion into the vena cava is also an indicator of malignancy. When faced with a smaller (

18/02/2022

How would you proceed with this case? This cat's big kidneys were investigated with ultrasound, and they looked ok at first glance:- cats often have whiter renal cortices vs dogs due to a higher fat content, but this kidney definitely measured bigger than it should at 4.66cm. There was no sign of cysts nor hydronephrosis (fluid-filled kidney often due to pressure build-up from blockages). So... what now?

Using ultrasound for guidance we aspirated the renal cortex and found lymphoma in both kidneys. Whilst the kidneys are super vascular, aspirates with guidance from ultrasound minimises the risk of haemorrhage and is a relatively safer approach than renal biopsy, and in the case of lymphoma gives you a diagnosis without looking at surgery.

This cat went on to be treated for lymphoma with chemotherapy after a successful diagnosis by Us Together.

10/02/2022

Puppies! Can you see the spinal cord? See the thick grey placental ring surrounding the black fluid, in which a little puppy foetus appears at the bottom in this video.
Us Together can make measurements to estimate the gestational age (in this case 31-32 days post ovulation based on crown-rump length and gestational sac diameter) and an estimate of how many puppies or kittens are expected. Handy if the mating date isn't known.

08/02/2022

In this video you can see what is called an atrial smoke sign. Normally blood flow can't be seen inside the heart, but in this case the heart isn't flowing properly in this lower left chamber causing what looks like swirling mercury or smoke. It's not a good sign- the patient is at high risk of a blood clot and needs immediate management to prevent this.
Us Together can scan hearts to judge whether they are starting to enlarge and need medicating such as in this case, taking the guess work out of older patients with murmurs or gallop rhythms.

04/02/2022

And we're back for 2022!
Here's another great use of ultrasound- staging for metastatic disease. Here's a medial iliac lymph node of a patient with a mammary mass, the node lives above the bladder inside the abdomen. Note how it is irregular in shape and hypoechoic (darker) vs surrounding tissue. It measured up to 1cm, much bigger than it should.
But this could be an upset and inflamed lymph node, let's not jump to conclusions! Aspirates were taken of the lymph node to help guide us via cytology. All done without general anaesthesia nor surgery- answers without the hassle with Us Together.

22/10/2021

What's your diagnosis?
12yo MN Beagle with raised ALP and a suspected abdominal mass on xray.
Ultrasound image shows mass effect (5.5X8cm) extending from the left liver lobe but the liver is generally hyperechoic and enlarged (see vs spleen echogenicity). The hepatic lymph nodes were enlarged at 1.6cm wide.
Aspirates of the liver are also shown.

What's your differential diagnosis in this case?

12/08/2021

Millie had a very comfy time being scanned today for her pregnancy! Congrats to the soon-to-be mum, plenty of pups in there today all looking very healthy. The ultrasound shows the heart beating, you can see the pup's head to the right and the stomach (small black dot) inside the main body on the left of the heartbeat marker

02/08/2021

The dangers of being on the road, copped a pie-on-thorax today.
Thanks Yarraville Vet Clinic and Strathmore Veterinary Clinic for your hospitality, see you next time!

16/07/2021

Another in the series of ultrasound-guided biopsies!
This mass was found during scanning a cat with free-fluid in his abdomen. Fluid makes x-rays almost completely useless as it turns the entire image white, whereas ultrasound loves it- see the large dark area on the upper left of the image?
A needle was directed into the mass for diagnosis with this cat which came back from the labs as a sarcoma.
The colour in the box was telling me where the blood flow was and where to avoid putting my needle in, making the whole process safer for the cat.

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Melbourne, VIC

Opening Hours

Monday	9am - 5pm
Tuesday	9am - 5pm
Wednesday	9am - 5pm
Thursday	9am - 5pm
Friday	9am - 5pm

Website

http://www.ustogether.com.au/

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Videos

Halo sign on a gall bladder- often this is seen in the emergency room when dogs are having an anaphylactic shock, but in this case the gall bladder wall was oedematous for a different reason- can you spot the enhanced liver vasculature? It's because the liver is hypoechoic. Aspirates of the liver confirmed intermediate to large cell lymphoma in this dog that had simply been off food and vomiting. See what you're missing with ultrasound! Complete diagnosis and care with Us Together. #ustogether #ultrasound #vets #vet #vetultrasound #vetsofinstagram #vetlife #vetsofmelbourne #vetultrasonography #vetstagram

In this video you can see the large adrenal mass has a soft tissue segment that descends down the phrenicoabdominal vein into the caudal vena cava. Sadly this has a very direct impact on prognosis due to high perioperative mortality, and palliation is often chosen. At Us Together we routinely scan the whole abdomen to look for abnormalities, not just the organ of interest. In this case we'd been asked to image the liver but found this mass as part of a thorough examination. Complete diagnosis and care with Us Together. #ustogether #ultrasound #vets #vet #vetultrasound #vetsofinstagram #vetlife #vetsofmelbourne #vetultrasonography #vetstagram

To cut or not to cut? Here's a great video of a descending duodenum from a vomiting kitten. The serosal-serosal diameter at the start of the video is 7.5mm. The stomach was moderately dilated given the 2 day duration of anorexia. How would you proceed in this case? Please write in the comment section below! The answer will be posted tomorrow. #ustogether #ultrasound #vets #vet #vetultrasound #vetsofinstagram #vetlife #vetultrasonography #vetsofmelbourne

Puppies! Can you see the spinal cord? See the thick grey placental ring surrounding the black fluid, in which a little puppy foetus appears at the bottom in this video. Us Together can make measurements to estimate the gestational age (in this case 31-32 days post ovulation based on crown-rump length and gestational sac diameter) and an estimate of how many puppies or kittens are expected. Handy if the mating date isn't known.

In this video you can see what is called an atrial smoke sign. Normally blood flow can't be seen inside the heart, but in this case the heart isn't flowing properly in this lower left chamber causing what looks like swirling mercury or smoke. It's not a good sign- the patient is at high risk of a blood clot and needs immediate management to prevent this. Us Together can scan hearts to judge whether they are starting to enlarge and need medicating such as in this case, taking the guess work out of older patients with murmurs or gallop rhythms.