Hello and thank you very much for coming to this presentation about scanning. The full a practical guide. I also wanna thank the organisers of this meeting for inviting me to give this presentation.
During this presentation, I'm gonna share with you some of the tricks that I've learned over the years in using ultrasound to diagnose problems in the neonatal and weanling fall. So one of the big areas of concern often is the abdomen in the fall. And so just like in the adult horse, we can use it to differentiate surgical from medical colic to Identify an abdominal abscess.
In particular, here, we're thinking about hotococcus eI and also to identify increased amounts of peritoneal fluid, peritonitis, or even GI rupture. So, it can be an extremely useful tool. It's important to again, know your anatomy of the abdomen and where in particular you're gonna be able to find the viscera of interest.
And so it's, it's learning cross sectionual anatomy instead of the way that we actually dissected animals, in veterinary school. So in the fall, the large colon is less well developed than in the adult horse, so you tend to see lots of jujunum ventrally. And also in the inguinal region.
And so they should be circular areas that have peristalsis. And although in the adult, they can measure as thick as 3 millimetres in diameter. In the full, the walls are usually thinner, more like 1 to 1.5 millimetres in thickness.
And we can also see the large colon and the secum. Again, the cecum is gonna be in the right para lumbar fossa coming down to the ventral midline. We should be able to identify the lateral cecal band.
We should see the right and left dorsal and ventral colons, but they're much less well developed. And again, there should be thinner as far as their wall thickness is, and also their luminal diameter should be smaller than in the adult. We did identify, some incidental jujua jujunal interceptions in neonatal fos when my colleagues went out, to a local standardbred farm to do normal neonatal foals, and they found actually 10 of these 18 standardbred foals had incidental interceptions while they were doing their abdominal scan.
And so you can see here. On the left is the normal wall of the neonatal fold, and it's actually quite thin and normal ingesta in the small intestine. And then here you can see that classic target or bull's eye sign with some fluid between the inner Loop and the outer loop.
And these resolved on their own without requiring any surgical intervention, and there was no wall thickness. In contrast, we do see jujua jujunal in a susceptions and certainly in the neonatal full is one of the more common causes for small intestinal obstruction. And in this case, you've got that target of bull's eye sign but with significant thickening of the wall.
You can see in both of these cases, this is a longitudinal view of this small intestinal in a susception, so very thicken outer wall, inner wall, lumen, and a distended loop that's a oral to that. So this is the area of inner sception at surgery. It's very useful in the neonatal fall also in identifying gastroenteropathy.
So we see fluid distension and ileus and many of these neonatal folds that have periparurin asphyxia syndrome. One of the things that we look for is gas in the wall of the small intestine, which is called pneumatosis intestinalis, as that's associated with a necro. Enterocolitis.
And if you look here, these little hyperchoic areas that you're seeing just under the serosal surface of that loop of small intestine is consistent with pneumatosis intestinalis. We can also see. Mucosa sloughing into the lumen.
And so this large echoic structure is actually peeling off. It's mucosa that's peeling off the submucosal layer of this loop of small intestine, again, in a full with necrotizing enterocolitis. And then these two, stills on the right, again, you can see gas, which is these hypercho echoes in the wall of the intestine in both of these loops, consistent with that necrotizing enterocolitis.
So, You can see it in the large colon as well, although it seems to be much less common, and that's just a review article that we did looking retrospectively. Well, it's not really a review article. We did, it's a retro retrospective study looking at abnormalities that we saw.
That were associated with pneumatosis intestinalis. So again, you can see these bright hyperchoic echoes here in the submucosa of this small intestinal loop and in that adjacent loop in the colon. We can see meconium and it has a variety of sonographic appearances.
And it's usually a hypoechoic to achoic sort of solid mass in the lumen of the intestine, and it can be surrounded by fluid or gas. So, in the video loop on the bottom right, you can see a slightly heteroic mass. In the lumen of the bowel surrounded by some a little bits of gas.
Similarly, we see that over here, in this loop with fluid distention of other, loops of intestine. And in the upper one, upper right, sorry. You can see this hypoechoic piece of muconium in the large colon surrounded by more achoicgeta.
So it can have a variety of sonographic appearances. Again, just like in the adult, we're, we're looking for small intestinal obstruction, and is it surgical in falls that are reflexing and colicky. So you can see that this fall has a a distended turgid loop of small intestine on the bottom left.
You can see the fluid just like kind of going back and forth in the loop on the bottom right. And then you can see some other loops of small intestine that have a more normal wall thickness and have some motility. So we have two populations of small intestine.
We have a little bit increase of peritoneal fluid in the abdomen, and again, surgical intervention is indicated as it is in this full. So here this fall has a, a markedly thickened loop of jujunum, anechoic fluid in this left loop. Some gas here in the right loop, which is what is creating that hyperchoic shadowing appearance.
That gas is in the wall of that loop of small intestine, and you can see, The oh my goodness. The mesenteric thrombus and the result, with, in this particular fo it did not survive, obviously. So very abnormal loops of small intestine.
What about looking critically at the duodenum? So these are usually slightly older folds that have had a history of chronic colic and teeth grinding. So looking critically at the duodenum and and young to weenly aged folds is really important because thickening of the duodenum can be associated with duodenitis and duodenal stricture.
Neoplasia really isn't a differential in these folds, so it's usually Inflammation, and, possibly necrosis and stricture. So on the bottom left, we could see a fluid-filled duodenum. With thickening of the duodenal wall.
And as we went, and looked at the abdomen, this is a different fold. You can see that you can't even see a lumen in the duodenum in this fold. It was so abnormal.
And this particular fall is the one that you see on the upper right with the severe duodenal stricture. So that fold did not make it survive. This is looking in the area of the cecum, so right para lumbar fossa and ventral portion of the abdomen, and you can see this markedly thickened cecal wall associated with the cecal volvulus.
And then, Gass tracking, . Into the wall of the secu and we can see over here on the bottom right. And what about parasites?
Well, we can easily visualise the acrid worm. Because it has, it's large and it's got this long like tubular appearance that we can see here. And again, you can see here in this fluid-filled loop of small intestine.
So we can see them sometimes in the stomach, jujunum, ileum, really anywhere along the way, but we're most likely to see them. In the stomach and did small intestine because of the more fluidity contents of those structures. So we can identify aids.
Lawsonia is another problem in weanling and slightly older falls, where they sometimes present with colic, but most of the time they're just dull, and they may develop edoema, and they have a very low total protein. And so you can see here that this fo has both small intestinal and Large colon involvement with thickening of both the jejunum there and right right dorsal colons, excuse me. So, Again, this can be used to confirm the diagnosis of Lawsonia until you get actually results of your other diagnostic tests.
Rhotococcus ei. Is another disease that's unfortunately all too common in falls and can be associated with either thoracic. Or abdominal masses.
So, in, falls that are not doing well, maybe have colic, have elevated fibrinogen, you can actually use, ultrasound to look at the abdomen. And here you see a variety of different appearances of, Falls with REI in their abdomen. So on the bottom left, you have a heterochoic sort of multiloculated mesenteric mass, which really you can't identify sort of any structures in that region.
Most of these masses will have small intestine or large colon, often adhered to the To that abscess. So you wanna look critically for movement of the GI viscera against the abscess, but I think you should always suspect that adhesions are, are present. Abscesses can occur in a variety of places like lymph abdominal lymph nodes.
So in the middle, you have an abscess which actually has a, a very thick capsule in it, and this is in an abdominal lymph node with fairly fluidy contents. Here's another enlarged lymph node with a very thick and like corrugated piece of small intestine, and that intestinal cor corrugation is often associated with peritonitis. So when you see that, one of the things you should think about is peritonitis.
And on the upper right, another abscess present within the abdomen. The lymphadenopathy that we talked about, we probably see most commonly in those lateral cecal band lymphoid tissue. And so both of these are looking at the lateral cecal band and folds with lymphadenopathy.
And so in the bottom left, you can see multiple oval to round hypocho to choic structures. Some like the one in the centre that looks like it has some cavitation in it. And then on the Right, you can see, again, multiple lymphoid structures, one with a cavitation in it associated with R equine infection and mesenteric lymph node abscessation.
Again, we can see localised or more disseminated peritonitis, and this is a fall that has this hypochoagicloculated fluid collection, that's adjacent to the right ventral colon. So, this fibrinous loculated structure is consistent with an area of localised peritonitis. There's no gas in there, so, we don't see anything that looks like perforation.
Although that still has to be considered, it seems less likely and maybe this could also be associated with or require some other infection. In contrast, this fall here has a severe fibrinous peritonitis, and you can see fibrine coating the whole serosal surface on the bottom left, so it looks like a shaggy carpet with very echoic peritoneal fluid. And on the right is some mesentery floating in this very echoic peritoneal fluid.
And you can see this is all associated with some totally devitalized abdominal viscera in this fall. And then just like an adult, we can see a rupture. So this is a fall that had a gastric rupture which you can see on the upper right.
So on the lower right, we can see a hyperchoic gas echo moving back and forth with respiration, which is the lung. We're on the left side of the abdomen, and so this curved structure on the bottom right is the stomach, and we can see that there's some hyperchoic gas echoes adjacent to the stomach in this peritoneal fluid. Sorry, my touchpad is extremely sensitive.
So in this peritoneal fluid here, we can see. Hyperco gas echoes. Right there.
Adjacent to the stomach. So that would make you think that the stomach is the most likely place of perforation. And on the bottom right, you can see again a pneumo peritoneum.
So there's gas and fluid. This is spleen and stomach. So there's a large area of pneumo peritoneum and that just shows the difference between the lung.
Outside the diaphragm and the gas in the peritoneal fluid in the peritoneal cavity inside the diaphragm, in a full with gastric rupture. This is a fall that where the dam actually accidentally stepped on the fall and the fall had a hemoabdomen. So we can see the blood swirling there.
In the ventral portion of the right side of the abdomen, we can see a lot of material here that's really difficult to identify. And then when we look really critically at the liver here, we can see this hypercho like split, and even what looks like a little clot here and probably some haemorrhage into the liver parrankima. So this fall had a fractured liver that was causing the hemo peritoneum associated with accidental trauma from mom.
We can also identify hernias. So, scrotal hernias are common in young falls. Usually they're readily reducible, so usually the intestine.
Is not trapped, and devitalized in the scrotal sac. Here's a loop of small intestine. In the scrotum outside the body wall here, cause this is the body wall.
These vessels are from some of the small intestinal mesentery. And on the bottom right, we can actually see the testicle of the neonatal fo, some mesentery, so that's long mesentery, and three loops of small intestine that are in the scrotal sac, adjacent to the testicle. So most falls with scrotal hernias don't need sonographic evaluation because they're usually readily reducible.
And there's not a significant problem with them. We also have umbilical hernias and falls usually they're not presented for correction until they're Probably weanling age in most instances. In the bottom left, you can see two loops of small intestine, one that's inside the hernal sac and one that's moving in and out of the abdominal wall.
So, that's this loop right here, and here's the hernia right there. So that's the size of the hernia. In the fold on the right, you don't really see anything that looks like small intestine.
You see this achoic, sort of globular material, and that's like a mental fat, that's herniating into the ventral umbilical hernia. And here's a, that, this loop right here is a loop of small intestine. And again, abdominal wall here and here.
But nothing that's strangulated within the umbilical hernia. So, then I'd like to switch gears a little bit and talk about looking at the umbilicus, which is a site of significant pathology in many, neonates, and sometimes slightly older fools. And so, we're gonna look at What these neonatal structures are.
And How we can trace them. So in this little schematic, you can see that the umbilical vein goes cranial to the liver and folds. There's really only one umbilical vein that is present going to the liver.
And then there's two umbilical arteries that are going back alongside the bladder, And In between them is the Eurachus. So we usually clip the ventral abdomen, these folds, and usually just a clipper width wide is long enough. And so we clip from the umbilicus all the way up to the xiphoid, and then from the umbilicus caudally to the udder or, or prepus, so that we can scan that area.
We usually do it standing, but you can certainly do it. In a fold that's in lateral recumbency. We don't do it in a full and dorsal recumbency, but this picture is just showing like where you would scan excuse me, clip, to do this examination.
So one or two clipper blades, you want width, you wanna use a high frequency transducer, and you only need a depth of feel of about 4 centimetres, or 6 centimetres really tops. So the normal umbilical structures measure about 1 centimetre in diameter, and the veins are thin walled and they have a hypoechoic or anechoic centre, and the umbilical arteries are usually thick walled because they're an artery, and they usually have an echogenic clot in the centre. And then the eurachus is just the potential space in between the two umbilical arteries that you can follow from the umbilicus.
Back to the apex of the bladder. So, they'll, if you measure the two of them together, the width is gonna be the diameter of those two arteries plus a little bit. So that's about 2.5 centimetres, and the same, the thickness is a little more because of the urachal tissue that's present there.
So, on the top, we have this typical appearance that we'll see of a normal umbilical remnants at the bladder where you have the two umbilical arteries. In this case, they're, they have an anechoic centre, but they're less than 1 centimetre in diameter, and they're thick-walled and then there's a little bit of tissue in between them, which is the collapsed urachus, and all the anechoic fluid below that is urine in the urinary bladder. In the loop on the bottom, we're following the right umbilical artery.
And so in this fall, the right umbilical artery is right there. It's thick walled. It has an anechoic clot, I mean, excuse me, achoic clot.
We're following it back from the caudal aspect of bladder towards the external umbilical remnant. So the anechoic structure to the right of it is the bladder, urinary bladder. So, we usually scan up cranially, looking at the umbilical vein initially.
And the only reason for that is that the fall usually tolerates this really well. And it's the scanning back towards the inguinal area where they get a little jumpy. So we do that last and, you know, if we upset the fall, that's the last thing we're doing.
So the arrows are pointing to two different umbilical veins that are normal as you go from the external umbilical remnant to the liver. So, they're there right along the ventral abdomen. You can see that, you really don't need much depth.
You see them in the 1st 2 centimetres from the ventral body wall. So you don't want like a 15 centimetre depth of display or you'll have a hard time identifying these. And then we, as we said, the umbilical arteries usually have this thick wall with the achoic clot, and you can follow them alongside the bladder, as you can see in these two examples here.
And then the urinary bladder, we also evaluate that. So that's gonna, Be evaluated to see it, does it look normal, if there's a problem like an early premature fall that has neonatal maladjustment syndrome or peripparture and asphyxia syndrome, Maybe there's some elevated creatinine and in a fold that's not producing much urine. You can have a very small urinary bladder like you see on the left.
And then the recumbent folds, sometimes you'll see a very large urinary bladder like you see on the right. That's a really full bladder and a, a fold that needs to actually get up and pee. So what about when these are infected?
So, the first thing that can be obvious is that you might have enlargement of that external umbilical remnant. And so that can have a number of different appearances. It can be filled with any type of fluid and or hyperchoic echoes consistent with gas, and often, there's lots of reaction in the subcutaneous tissues around it because there's an infection there.
You could see this in conjunction with the umbilical hernia as well, or, on its own. So these are just two examples of, an infection of the external umbilical remnant area. So all of this, this is in a long axis looking at the swelling, but looking transversely across it.
So you can see there's a, a large, swelling, . That has hypocoic material and then this sort of focal area that looks more like an organised structure, which should be the external umbilical remnant, but sometimes recognising which structure it is, is difficult unless you follow it from inside to outside. So, as I said, we look at the vein, so any enlargement of the vein.
Particularly with either anechoic or choic fluid or thickening of the wall of the vein is abnormal. So on the bottom right, you can see there's a hypoechoic thickened wall of the vein as it comes through the body wall. So that's just, inside the abdominal cavity.
The contents are choic with a slight hypoechoic centre, so those aren't normal contents of the vein. If we go directly above that, you can see a very thick walled, Umbilical vein. It, it almost looks encapsulated with hypochoic fluid within it, and that's a short axis and corresponding long axis image of the umbilical vein as you go up towards the liver.
And then it is very important to look at the liver of the fall. So in this instance, you may actually have to go up along the right body wall to follow the umbilical vein into the liver. And if you do That you can see it in this particular fall on the bottom right, there's a very enlarged umbilical vein filled with purulent material going into the liver, and then we look at the rest of the liver to see if there's any evidence of other hepatic abscessation or if it's all combined to the umbilical vein.
Another example of a very thick and enlarged umbilical vein on the bottom left with sort of lacy fibrine and more anechoic fluid contained within that very thick walled umbilical vein. And on the right is a longitudinal scan. Caudal is to the, excuse me, caudals to the left.
So the anechoic structure is the urinary bladder. And then you can see, The urachus is right here. That's urachal tissue, and then you see all these hyperchoic echoes in the urachus here, associated with the urachitis and also marked thickening, all around it.
So, gas in the eurachus, in most cases, it's not coming from an open, Eachus, so a urachal, persistent urachus, it's actually coming from anaerobic bacteria that are present within the Eurachus creating that infection. And then some examples of abnormal umbilical arteries, so you can see they're thick walled. They can have this, as you see on the bottom left, this verychoic inner rim along the inal surface of the vessel containing fluid within.
On the bottom right, you see a very enlarged, you know, poorly defined umbilical artery under the arrow. And on the upper left, again, you see a thick-walled umbilical artery with a hypercoic rim and then anechoic to hypocoic fluid within. So, three different examples of on-flow arthritis.
And then, the urachus is obviously that structure in between the two umbilical arteries. So you're looking to see if can I identify the umbilical arteries. Like here, you can see one of the umbilical arteries is here.
The other one should be here. And all that swelling, and thickened tissue is really between the two umbilical arteries. So that's infected urachus again with probable anaerobic involvement.
And you can see this is extending out to the external umbilicus, so that infection is going out to the external umbilicus. And another example of a fool with Gass here, In the urachal structures. And here you can see one umbilical artery and the other umbilical artery, and you can see some hypoechoic fluid.
But as you got back towards the external umbilical remnant, you'd see a lot of gas. So fluid and gas, and thickening of the eureachus. So another example of urachchiis.
Now you can also see haemorrhage in neonatal folds associated with umbilical enlargement, and that typically appears as anechoic to hypoechoic fluid that not only is around the umbilicus. And often it's around the umbilical structure that's abnormal, but it often extends into the retroperitoneal area. So if you look on the bottom right loop, you can see a thick walled umbilical vein.
It's got heteroic fluid in it, and all around the umbilical vein is All this loculated fluid that you can see here. And you can also see some achoic material which may actually be some clot, and this is all in the retroperitoneal space. So here's body wall.
This is a retroperitoneal. Space. This is gastrointestinal viscera in the abdomen.
So, you could be pretty, and then one of the questions you might ask when you're find this sonographic appearances, was there a lot of haemorrhage from the umbilicus. At part tuition, and a lot of times the answer will be yes, and this is just another fall with a similar issue of a large amount of Fluid here. Around the umbilical vein and vary amounts of clot within this thick walled umbilical vein.
So certainly consistent with probable haemorrhage. Now, the haemorrhage may end up with secondary bacterial infection if the foal has neonatal sepsis. This haemorrhage can sometimes extend into the bladder.
So if you look at the fold on the left, you see all this hyperchoic material in between those two umbilical arteries. So that's in the urachus, but it extends into the urinary bladder. So there was haemorrhage, those are blood clots, and that was haemorrhage that extended into the urinary bladder.
And most of the time that resolves on its own without needing surgery, but we have had instances where the fall had surgery to remove a large clot. And then this fall has a more lacy, hypochoic appearance to the material that's present in its urinary bladder, but also consistent with haemorrhage into the urinary bladder at perurition. We talked about a pain urachus, which is just a tubular connection, where the urachus didn't close, postpartum and urine can dribble out through that.
Tube. And so on the left is a longitudinal view of the, a persistent urachus. So it's usually a very small tube that connects the bladder apex to the external umbilicus.
And on the right is looking at that pain urachus in between two umbilical arteries. Diagnosing your peritoneum and is another like excellent application of ultrasound and folds, and this can be a, you know, significant problem in that neonatal fold, . So you can see that in this One study, all folds had large amounts of anechoic fluid in their peritoneal cavity.
This collapsed folded bladder with a dorsal defect they described in 10 of 31 folds, and urachal abnormalities in 31 folds. And there was a significant correlation between ultrasound and surgical findings. I think the collapsed folded bladder.
We see in the majority of falls with a ruptured bladder. But you don't always see the dorsal defect. So these are two examples of where you do see the dorsal defect.
So on the bottom left, you have this collapsed folded appearance of the bladder right here, so it's folded on itself. You have the two umbilical arteries right here. And you can see that there is a dorsal defect in the bladder where fluid can leak out into the abdomen and you have a large amount of peritoneal fluid, and then the corresponding long axis view of the rupture is immediately to the right of it.
The far right video loop is another full. With a ruptured urinary bladder, and that's kind of an unusual appearance because the bladder, although it's collapsed, it doesn't really look folded on itself. And you could clearly see where the dorsal bladder rupture is, and the two umbilical arteries which are suspending the bladder on either side, those become the round ligaments of the bladder, as the full ages.
Two other examples of Ruptured bladders where you can see collapsed folded bladder. On the bottom right, with again, that dorsal defect that you're visualising. On the bottom left, you can see the dorsal defect as this thin area and the walls of the bladder right adjacent to that look a bit blunted and you can see the two umbilical arteries.
Again, lots of fluid with small intestine, jujunum freely floating in that fluid. And then on the upper, right, again, you see the umbilical arteries kind of suspending the bladder. And you see that collapsed folded bladder, but in the upper right, you can't really see where the defect is.
But that still is consistent with a ruptured bladder. So, That appearance, in contrast to the aneury full or the fold that has a small urinary bladder, the bladder just looks small and round or oval. It doesn't fold on itself, after urination.
So if the Eurachus is ruptured, You will have fluid that comes into the urinary bladder. Normally, the bladder will look intact. It doesn't fold on itself, but fluid is leaking out, in the eureachus, so you wanna look critically along the eureachus for fluid dissecting along the eureachus.
But this fluid In the peritoneal cavity with a small intact bladder should make you think about the urachus as being the primary problem, which is a, a fairly common site of leakage. And then the last places there's the possibility of a ureteral rupture and you'll have retroperitoneal fluid. So this particular fold that had ure peritoneum has fluid leaking out in the retroperitoneal space here, adjacent to the Eurachus.
And also has fluid leaking out around the kidney in the retroperitoneal space. So, in the, you, you always have to keep in mind that ureteral rupture is a possible cause of urop peritoneum and falls, and so you wanna look at both kidneys as well as the urinary bladder just to make sure that there is no teral involvement. So what about the lungs and folds?
Ultrasound can be really useful in looking at the lungs as well. And so we may see radiating come tail artefacts which are consistent with an interstitial disease. So you can see this with a wide variety of issues, but usually, a viral pneumonia or ARs and folds, .
These cometel artefacts are really called bee lines now, or lung rockets is the other term for them. So there are these white radiating artefacts from the periphery of the lung. Remember that they can be caused by quite a lot of things, but if you have coalescing comet tail artefacts, you wanna think about interstitial disease, possibly viral disease.
The Falls, . Can commonly have rib fractures. And so ultrasound is the best way to diagnose those, much better than radiographs.
So these are, different folds with fractured ribs. They're usually close to the coststrochondral junction. They may even involve the costtrochondral junction.
Often multiple ribs are affected. They're commonly in the cranial ventral thorax, so the possibility of myocardial contusion, exists, so you wanna look pretty critically. So in the full in the upper right, you can see that that fractured rib, both, Pieces of the rib are pointing into the thoracic cavity.
So lung contusion, thoracic haemorrhage are all possible, as is myocardial contusion if that broken rib happened to be over the heart. On the bottom right, this loop, you can see it's a 4th rib fracture. Proximal is to the, or dorsal is to the right and distal is to the left.
So you can see that the proximal fragment is pointing out towards the skin. And the distal fragment is pointing in towards the lung. The consoconal junction, you can see coming in, with respiration there.
And then this fall has radiating comet tail artefacts, over the heart area associated with rib fractures. So those radiating comet tail artefacts are most likely associated with pulmonary contusion. Associated with the adjacent rib fractures.
We talked about hotococcus equine in the abdomen, so we also need to remember that it's a significant problem, and ultrasound again is a good screening tool for identifying REI in the lungs and looking for REI abscesses. Well, the REI abscesses, as you can see in this radiograph, are scattered throughout the thorax. Many of them are located adjacent to The visceral pleural surface of the lungs, so we can see them sonographically.
And here you can see two different types of REI abscesses, the more anechoic to hypoechoic one on the loop on the left, and then the circular abscess on the right with hyperchoic contents, within, . So you have those two types of appearance of REI abscesses, as well as you can have areas of hepatization and consolidation associated with REI or other infections. So, these are areas of somewhat hepatized lung.
The one on the bottom right looks the most liver-like, but the ventral lung lobe is expanded. The ventral tip of the lung right there is rounded. You can see little fluid bronchograms in that area of lung.
So that lung right there is the most severely affected. Lung, and when you see expansion or rounding of that ventral tip, you have to get worried about tissue necrosis and severe inflammation in that portion of the lung. If you contrast that to the consolidated area on the bottom left, you can see little bronze.
Branching throughout a tubular ventral portion of the lung that has a, excuse me, a triangular ventral portion of the lung. So you can see all the little airways, the ventral lung maintains its normal shape. So that's consistent with prankal consolidation, but you can see that it's not as severe as the bottom right full because It has air bronchograms instead of fluid bronchograms, and the lungs maintaining its normal shape.
We can often see similar areas of consolidation like throughout the lungs, so this is just in the mid portion of the lung lobe with a somewhat circular area here which may be a developing abscess. It would be something you'd want to follow. And rarely, or maybe I should say rarely, but less commonly, we'll see falls with fibrinous pleural pneumonia for a variety of reasons.
Sometimes it's aspiration pneumonia, sometimes they're just septic falls. So this is looking at, several different falls. So here we have the ventral lung.
We don't really see well either air or fluid bronchograms, although we have air here in this portion of the lung. It's, it's not very collapsed, so the pressure of the surrounding fluid hasn't really compressed it. So this looks like an area of pneumonia.
We've got fluid, we've got a fibrine layer. So this is actually a sheet of fibrine lining the parietal pleural surface of the lung, and we can see loculations. Along the axial surface of the lung between the lung and the diaphragm, which is down here.
This is a close up of a different fold that has sheets of fibrine lining the parietal and visceral pleural surfaces of the lung. So this aerated echo here with the coalescing comet tails is the visceral pleural surface of the lung. You can see the little tip looks collapsed, mostly, so this is primarily at this tip, a little bit of compression atleticis.
Again with the fibrous fibrinous pleural pneumonia. But we don't see any loculations right in that area. And then this is looking in the cranial mestinum, so you always wanna look in front of the heart as well, to see what pathology you can see.
And there's some aerated lung here. But it also has hypoechoic areas in the prankima, so some consolidation. We've got a lot of echoic material which could be fibrine, cause here's some anechoic fluid.
This is the mediastinal septum. It's actually pushing the mediastinal septum to the left. And here's fluid in the cranial mediastinum on the left.
So, fibrinous pleural pneumonia in a full. So with that, I'm gonna finish this presentation. I'm happy to again entertain any questions via email.
It's reef at vet.upenn.edu .
And . Yeah, there you have it. Thank you very much for coming.