August 11th, 2023

Equine Medical Ultrasound Cases

By David Grant

Gayle Hallowell has an amazing CV, which you can see in detail at the beginning of this veterinary webinar. After 15 years as professor in veterinary internal medicine and critical care in the Nottingham veterinary school, she left academia in 2022 to join IVC Evidencia in the role  that you can see above. She continues to do some clinical work as a specialist clinician with Pool House Equine Clinic.

She has wide ranging interests and in particular ultrasonography, making her ideal for this presentation. 

The outline is as follows:

·      Medical ultrasound top tips

·      Are abdominal ultrasound evaluations really worth it?

·      Approach to the complex medicine case

·      Ultrasound of a selection of medicine cases

She begins with some general advice on ultrasound machines and maximising the image-some twiddling with knobs required. For those new to ultrasonography or contemplating its study, there are several webinars in the WebinarVet archives that cover this comprehensively, which would be complementary to Gayle’s presentation..

General advice continues on the ultrasonographic evaluation of medicine cases.

·      Start with a thorough evaluation of the abdomen, before the thorax.

·      Low and high frequently evaluations, -low for solid organs, high for intestinal wall thickness

·      Preparation is key-clipping, the use of spirit/coupling gel, and patience and invention. Most importantly save your images as cineloops.

In the outline Gayle asked if ultrasound abdominal evaluations are worth it. To answer this question she cites research, subsequently published at the colic symposium 21.

This was a retrospective study, from 2015-2020, evaluating the frequency of abnormalities detected using transabdominal ultrasound in cases involving weight loss, diarrhoea, pyrexia of unknown origin and recurrent abdominal pain. The study confirmed that ultrasonography was a mainstay for a range of medical cases. A summary of the ultrasonographic abnormalities detected was as follows: -

Abnormalities were found in 80% of the examinations 

·      19% had thickened small intestine

·      40% had thickened large intestine

·      21% had thickening of both small and large intestine

·      4% had abnormal motility

·      8% had either an abnormal peritoneal fluid amount or appearance (peritonitis and mesothelioma)

·      8% had other abnormalities, which were predominantly masses or other abnormalities in solid organs such as the spleen, or evidence of chronic renal failure

Nine high quality ultrasound images are shown next depicting normal and abnormal intestine.

The rest of the webinar describes a further nine clinical cases. For each one a brief history with clinical findings is given with the relevant ultrasound images and final diagnosis. For example, the first case is a 20 -year- old warmblood gelding, which initially presented with signs of colic and then developed weight loss over an eight -week period. Superb ultrasound pictures and extraordinary post-mortem findings vindicated the u/s diagnosis, unfortunately for the horse.

All the cases are quite fascinating with many good outcomes, and in conclusion Gayle summarises:

·      There is often a high yield using ultrasound, especially if you have additional clues

·      Get the settings on your machine to be the best they can be for your caseload

·      Ensure you fiddle with the knobs throughout the scan

·      It’s all about attention to detail and finally- ‘if it doesn’t look right, it almost certainly isn’t!

This is an excellent webinar and like all international experts Gayle makes her speciality look easy. However, she has packed a huge amount of specialist training at university clinics, leading to European and American diplomas and a PhD n her twenty years post qualification. Ultrasonography is a phenomenal growth area in veterinary medicine and this webinar will be an inspiration for many to follow in Gayle’s footsteps, especially equine practitioners

Watch Webinar