Take Your Scanning Skills (Case)

Question

What is this structure?

Can you see any abnormalities?

Answer

This structure is the urinary bladder; the two echogenic structures in the dependent portion of the bladder are uroliths. They are confirmed as uroliths as they cast a distal acoustic shadow, seen as the  dark area deep to the surface of the uroliths, this is caused by the mineral content of the urolith;  the ultrasound beam is not transmitted through mineral structures such as bone and uroliths and are absorbed or reflected, resulting in the bright interface at the surface of the structure and the deep region of shadowing extending into the deeper part of the image.

The wall of this urinary bladder is also irregularly thickened, reflecting cystitis associated with the uroliths.  Uroliths will always be in the dependent portion of the urinary bladder and therefore when scanning the bladder it is important to ensure that the entire bladder is imaged as uroliths can be surprisingly easy to miss if the urinary bladder is distended.

Bladder wall masses, such as neoplasia or granulomatous masses will be composed of soft tissue and therefore will transmit the ultrasound beam, so that the structure of the masses can be seen and there is no distal acoustic shadowing.

How did you do? If you’d like some very practical help with your ultrasound scanning, read on for details of the Abdominal Ultrasound Mini Series online course. Tutor Anna Newitt has helped hundreds of veterinary surgeons like you to develop their skills and confidence in scanning their small animal patients. Join them now!

Dorsal Carpal Region Wound

Question

This large open wound is over the dorsal carpal region. What are the problems associated with the wound and what possible options for closure are there?

Answer

This is a large wound over a site of high motion with limited surrounding skin in the area. Closure by second-intention healing could be lengthy and lead to suboptimal function and cosmesis. There is no local closure or axial pattern flap available, so the best option would be to plan and place a full-thickness skin graft.

Practical Wound Management ( Test Your knowledge)

Question

This middle-aged Labrador presents with this enlarging cutaneous mass on her lateral-caudal thigh. What are the key steps in planning definitive treatment of this tumour?

Answer

Initial fine needle aspirates or preferably incisional biopsy should supply the information on the type of tumour present.

This should determine the amount of further staging required and the margin of normal tissue to be excised around the tumour. Surgical management in this area can be difficult due to the increased skin tension and minimal subcutaneous tissue, so a clear surgical plan for excision and then precise execution of the reconstruction is essential.

How Do I Know My Patient is A live?

Question

You are using a pulse oximeter on a cat undergoing ovariohysterectomy under general anaesthesia. Partway through the surgery the pulse oximeter begins alarming and reporting an oxygen saturation of 87%. What steps should you now take?

Answer 

Look at the cat – do the mucous membranes look blue (this is unlikely as our ability to detect cyanosis is quite poor)?

Move the probe – repositioning is very important as a first step as the capillary bed becomes squeezed and the monitor then may give a false reading. Once the probe is reattached, see if the reading has changed (usually it then will increase).

Check the monitor for a good signal, determined by either examining the waveform generated by the pulse oximeter, or by observing a signal indicator light (usually green).

If the reading is still low then a search for a cause must begin. Preferably confirm the reading using blood gas analysis if available. However, an arterial sample from a cat will be difficult to obtain.

How You Dealing With Open Wounds

Question

What are the key parameters to assess for this large open wound over the right pelvic region?

Answer

Open wounds should be assessed under a number of parameters including:

whether the wound is still in the inflammatory phase or not

the presence or absence of granulation tissue; the degree and type of wound exudate present

whether the wound edges are attached to the underlying tissue

whether any epithelialisation has occurred

You can then make decisions regarding the most appropriate approach by the surgeon to the wound.