Good evening everybody, and welcome to a Thursday night members webinar. My name is Bruce Stevenson, and I have the honour and privilege of chairing tonight's webinar. I don't think we've got any new members in tonight, so, I'll dispense with the usual housekeeping.

Remember questions and answers in the Q&A box, and we will handle those at the end. Our speaker tonight, Pete Manus is no stranger to the webinar vet. So, it's good to have him back.

And Pete graduated from the faculty of Veterinary Medicine of the Aristotle University in Greece. And then he completed a diagnostic imaging residency at the Royal Veterinary College. Pete worked in first opinion practises as well as referral hospitals in London, and for a year at the Swedish Agricultural University in Uppsala as a staff clinician in diagnostic imaging.

In 2000, he moved to the Royal Veterinary College in London, where he became a senior lecturer in radiology and remained there until joining Dick White referrals in May 2017, where he is currently a consultant radiologist. Pete is a European and RCVS specialist in veterinary diagnostic imaging, as well as a fellow of the Higher Education Academy. He is a regular author, speaker, and CPD tutor on small animal radiology, ultrasonography, CT and MRI.

Pete has authored the book, Practical Small Animal Ultrasonography, Abdomen. Pete, welcome back to the webinar, vet and it's over to you. Thank you, Bruce.

Thank you for the introduction and welcome everyone. I can understand after a hardworking day, especially the people that they are alive. Hopefully, it will work your time.

In the meantime, just, to, to update a little bit my CV. I'm, I'm the head of diagnostic imaging at Dick White referrals, currently. And this is a lecture we're going to go today about ultrasonography of very productive system.

I will try to cover the basics so everybody can go back and start, you know, scanning and try to see the reproductive system. As always, I will, intellectuals like this online. I will stop my videos, so at least I don't have my image covering part of my slides, but I usually start by keeping my image open so that everybody knows that I am alive when we record these things.

So, I will stop my video and start with the lecture. So as soon as the system decides. Every time I'm going to, to do an ultrasound, I always want to know why.

By the way, if you have any questions, please post them on the chat room and somebody will alert me, maybe Bruce or Amy, and I'll try to answer them or if you prefer in the end it's up to you. Now, as I said, every time I go to the nuro, I need to know why there is no such thing. I don't have a clue.

Let's put a probe and find out. And the same goes for the reproductive system. Of course, everybody understands the major indication for reproductive system is pregnancy, checking the foetus, checking for any fluid.

In the uterus, taking any other endocrine anomaly possibility, dysuria, you know, especially this male dogs with big prostrates, hematuria, maybe something nasty, bloody discharges, painful defecation. How many you had some people with locomotor, some of those with locomotor problems that they came to you supposedly like hips and then that being the prostate. So we have a lot of indication.

I'm not going to go through the whole list, but there are many of those and you need to know why you do the scan. Now, when we come to a very reproductive system, We will start with the ovaries. I know in the United Kingdom for those practising in the United Kingdom, it's not always there because most of the animals we see tend to be neutered.

So to find the canine ovaries, first of all, we locate the kidney and this dog, it happened to be somewhere there. Sorry about my drawing, really, not so good as my little one will tell you. And then we look up to 2 centimetres behind.

Here I have the, my resident actually holding the probe, finding the left kidney, and then we just look 2 centimetres behind that, finding out probe, top and bottom, trying to find the ovary. And that is a technique to start with, not always as easy. In antrus, the ovaries can be very difficult to find.

I'll show you examples, so you will get some ideas, OK, but they tend to have a similar ecogenicity with the surrounding tissue, so they may not be. Standing out. Protosis is just things are easier because you know we have the follicular cyst and then, you know, ovulation and things are much easier.

You have something behind the kidney that has some cystic structures make it easy. Keep in mind, obodies are relatively superficial and they, we are going to use a high frequency transducer because we don't need to go too deep to evaluate. Also, ovaries are not retroperitoneal, contrary to Kiris, they're intraperitoneal.

So if we have something big, they may drop all the way down to the bottom of the abdomen. Now, in proestors, generally the ovaries are all bad and some people describe it bean shaped, OK, roughly about 1.5 centimetres, if you like long with ecogenicity, that of the renal cortex.

It has been described that in a 25 pound dog. The ovaries, if we think the length, the length, the width, and the height are about 15 millimetres length, 7 millimetres width, 5 millimetres height. Of course, larger dogs who tend to have bigger ovaries, but usually that difference is in the region of 2 millimetres, so don't lose your sleep.

That is hugely different. In cars, of course, they are smaller. We will start seeing follicor pretty quickly within the first week, OK, in proestrus, and they start small, they can become quite big.

You will say just 1.2 centimetres or 12 millimetres what you want to say, but think that you're going to use a depth of about 3 to 4 centimetres. So that will be quite visible when it occupy.

But it's about 1/3 or 45% of your screen. Now, when we come to estrus, the follicles will reduce in numbers. Some may develop up to 2.5 centimetres.

And then we have the ovulation and after that, we have the corpus hemorrhagicum and then that is being reabsorbed and we have the corpora lute. So, while originally the oval, I have here one kind of an extreme example to give you an idea, it's quite similar to the surrounding without the callipers, you may have. Trouble.

Sometimes it can be easier because they are a little bit brighter than what you see here. I'll try to outline the ovary and you can see this oval shape. Sometimes it looks like it has a notch at the top and some people they, they, they call it a beam shape.

So when it is in an, it's, it's difficult to see. With high frequency transducer patients and slow movement of the probe, you will eventually see it. And as we said, up to 2 centimetres behind the kidney.

Now, when we are in Pro to sent this to suddenly we start seeing the, the follicular sis, and you can see here. There are more than one. Here's another one with a lot of similarly sized.

See, so suddenly you see something behind the Kidney With a lot of cysts. So you know that you are looking at, basically, the ovary. Now, funnily enough, sometimes my residents were not used to see the ovaries, sometimes because we don't see many not neutered females.

We may get a dog, you know, that is in rosters with a lot of follicular cysts and this is something cystic behind the ovary. And usually, especially for the younger of those, they will go, what is that cystic thing behind the kidney? And usually I will tell them think and suddenly, you know, it comes to mind.

It's, it's one of those things. In the UK, most of those are neutral, so we end up not seeing many ovaries. Now, having said that, in the area that they have the arrio hysterectomy.

It looks like almost a nobodyanaister sometimes, so you have to be careful how you interpret that, especially with these questions on ultrasound. is the animal neutered or not. Now, ovarian masses, OK.

Here we had actually one, this is going to play. There we go. I hope you can see the video of this cystic kind of huge ovarian mass that we had actually in a dog.

It was a surprise. You can see at the bottom of the is the kidney coming. Actually, don't worry, we have a little bit of fluid around there.

So a little bit of asci is in this dog. And basically, That was a surprise mass that we found and it was in a dog that basically we found the kidney and suddenly there is the mass that you can see the kidney here below. And here is the mass and we say, oh, wait a minute, that's behind the kidney.

Could that be an ovarian mass. And here you can see also a little bit of the spleen with some hypoechoic nodules and some ascites for those wondering. Now, let's see if I can clean the screen here.

And it is spent, OK. So basically, this particular one. Came back as a sex called stromal tumour.

When we come to variant tumours, we have surface epithelial tumours like adenomadenocarcinoma. We have sex gonadal stroma tumours like, you know, this guy here, they can be granulos cell, they can be faecal yoma leoma. We have germ cell tumours like this this geminoma, teratoma, teratocarcinoma, and we have missing chema like a angiosarcoma, angioma and liomyoma.

And till we take them out or we take an aspect or a biopsy, we can't really. Know what it is just from the appearance of ultrasound. Now, uterus, when it's not pregnant can be difficult to see.

Usually when it's not pregnant, it can be, you know, 4 millimetres in diameter or 4 to 6 millimetres in diameter. Now, if the animal is older, it has some previous pregnancies, makes life easier because then we can see it a little bit more, it's more closer to one finger thick a centimetre about. OK.

One very important thing to keep in mind is that during estrus, It becomes a large and hypoechoic and we'll say later on during issue, it may have a smidge of fluid inside the lumen. Uterus, it's kind of the or the organ I usually recommend to people to start transfers to search for it. Most of the times when we talk about ultrasound, We are talking, finding the organs with the market which in our ultrasound pro is this line we have over here facing to the head.

So we get kind of a surgical or a dorsal plane. Now, uterus for me it's the exception. I think it's easier to find it working transversely with a marker up.

And usually the way I like to position the animal is animal on the side like you see here, bend to the knee and ask your assistant to hold the leg up and then place your probe parallel to the table with the marker upwards on the left side. OK. Transverse to the skin.

The on that orientation, you will find the bladder as you have your screen. You will see the bladder on top. You will see the colon and the colon usually contains faeces and some shadowing, and somewhere in that area, we're going to see the uterus as a hypoechoic around its structure.

Not in all of them, it can be to the left, could be between the two could be just to the right. So as we slide back, we will see it and as we slide cranially again, maybe the one transverse. Image of the uterus and then we see it splitting into the two horns.

When we find it. Then we can always rotate the probe counterclockwise and then make the uterus as I will show you in the image looking long. Here is the image of a uterine stump, OK.

And as always, we make use of the urinary bladder. So the more urine there is better. It provides an acoustic window so we can actually find and we can see here the stomach will look like a uterus anyway.

You can see the sudden edge. Then we have the Endometrium and the lumen with a little bit of mucus here that we can actually see. Now And as I said, that is the only organ that, oh, I press the wrong button again.

Give me one sec. We don't need any close caption. And that's the only organ that is actually easier to find transversely and then rotate.

And then I get sometimes the question and that's why I have these slides here. Oh, is there any chance I can confuse the uterus on your right with the loop of intestine on your left? And I don't think there's any chance you will do that.

Why? First of all, small intestines, you remember they have these layers, we have the mucosa, we have the submucosa, we have the muscularis and the serosa. Black, white, black, white.

Usually I say think Newcastle United, there's a team here, you know, that has black and white stripes. The uterus doesn't have this kind of layers. We just see this hypoechoic wall.

Secondarily, intestine, if you wait a little bit, you will see a little bit of perist that some movements. You shouldn't see it in the uterus. If you think you have the uterus and so that it moves, not to you unless it's really pregnant and there is a foetus moving around, it's not the uterus.

And normally, we don't have any gas or fluid in the uterus. We'll talk about the situation. We may have a little bit of fluid in the rus.

But otherwise, normally we shouldn't have any gas or any fluid there. So I don't think you will come into a situation of confusing the uterus with an intestinal lobe. Now, as we progress in the Pros mistrus, the uterus becomes more hypolicoid, more edematous, more big, and you may see a little bit of fluid inside.

But it will be a, a very small amount of fluid. Why do I say that? Sometimes you may get a case that the animal is coming and the question is, do we have any close bio?

And the animal is is true doesn't have so much signs. You see a smidge of fluid, a very little amount of fluid in the uterus and you wonder, oh, do I have bio. In this case, it may be better to check it after these tools and don't be surprised if this little amount of fluid will disappear.

OK. Now, we can find fluid in your uterus, but it's not gonna be normal. You know, whenever we see it, it is abnormal.

And it can be pyometer, it could be hydrometer, it could be muomera, it could be amometra. And the problem we have is just by how the fluid looks like, you cannot say what it is. Most people will go, oh, it's black, so anechoic, you know, anechoic is, it's jargon for ultrasound for black, and they go, it has to be hydrometer muometer.

But I'm afraid pyometer can look anechoic. Even emometer sometimes may, you may get an area that looks anechoic, so it's not as clear. Usually when it is eco ecogenic, we may stick more to pyometer and amometer.

The other thing is, as a rule, you don't put a needle to get the fluid to find out what it is, because especially with pyometer, the animal is already compromised. The last thing you want is to have some pus dribbling out. So you never ever put a needle in there to get a sample.

You say why you say that? Because people tend to ask stuff. Here I have a pyometer in a dog and we know it was a pymeter because first of all, it was open and we can see some fluid into the lumen.

Now that's a bit too much forors, but if I only had this part here. I will actually, and the animal was in estrus, I would be a little bit more questioning whether that is true parameter or just estrus. He is attached too much.

Of course, it can come much more than that. Look how irregular the world looks like, look how much ecogenic you see all this fossite here, fluid we have, and of course, the X-ray from the same animal and you can see these loops. Of the dilated uterus and we know it's uterus because we can actually follow it back going towards the pelvis.

You know, small intestine doesn't. Sometimes it may not be as clear on radiographs, but you will never have that confusion on ultrasound. Keep in mind as you scan, you know, that basically the horns will actually twist.

And sometimes you may cut through with your beam, sorry about my drawing, through various sections of the same horn or both horns. So you may see a lot of parts of fluid filled uterus like we see here, basically the ventral to the colon, which is the faeces you see on the left-hand side. And of course, another more well described image which you can see the bladder, you can see the colon, and you can see the faeces with the shadowing in the colon, and in between, we can see the uterus and horns as we cut through with the mildly ecogenic fluid in another animal with pyometra.

Here's another a little bit darker fluid within the, the uterus and people may go and say, oh, that may be muometer or hydrometra. I'm afraid to disappoint you. That was also a pyometra.

So be very careful how you interpret the fluid without knowing anything else. Here is the left uterus of another dog that also had cystic endometrial hyperplasia. Don't worry, we're going to talk about that.

It had some cysts really in the wall and also that's a precursor usually to pyometer and you can see here the fluid within the lumen of this horn which is to the left as indicated by the sign. Now Sometimes we can see the world being thicker like we have here. OK.

And you can see a lot of small cysts within the wall. In cases of cystic endometrial hyperplasia. Now cystic endometrial hyperplasia is a precursor, precursor to biometer.

Also, the fertility of the animal is quite reduced. It's not disappeared. But you know, it's not like a normal animal is well reduced from that.

So it is something you will have probably to warn the owner and the owner has to decide whether they want to continue, maybe they want some puppies out of it, or they would like to do an ovar hysterectomy before the possibility of developing a pyometer that would make things a little bit more complicated. Here was a case we had and we actually saved the, a video so you can see the left horn of that animal. You can sit on the top with all these small cysts in the world value sizes and some of them quite chunky and we try to follow it actually to the body of the uterus was the bladder and you can see how many cysts we have.

In this big wall, it's, it's not such a tricky diagnosis. In some animals, especially smaller one, if you use a linear probe, you may get a better image and you can see this brightness below the cyst. It's what we call an ultrasound acoustic enhancement, which usually we see distal to fluid-filled structures.

So that's another thing that confirms that this anechoic round the structures we see over here are cysts. And just in case, you know, you missed it, here is a frozen image and you can see clearly this increased brightness below. This Cystic lesions, what we call acoustic enhancement.

OK. Here is again another wall and we can see all these cyst. We can actually see a little bit of ascites around and you can see the fluid also in the lumen because we also had pyometra in this case.

OK, this was the case that I showed you with the ovarian mass that you can see over here coming into this video and then followed behind by the horn, the left horn that you can see the wall is full of cysts, the lumen is full of fluid, and also we have ascitis and you can see again the relationship between the kidney and the ovary. Remember, to find the ovary, we look up to centimetres behind the kidney. Uterine neoplasia.

Here we have actually The cervical area of the uterus that has this kind of mostly hypoechoic. Ma It's a rare thing to find a mass in the uterus. When we find it's usually an adenoma, adenocarcinoma, liomyoma, liomyosarcomas.

We can have other tumours, but they are very rare to see on ultrasound. Now the Taj Mahal of very productive ultrasonography and that is pregnancy. Pregnancy, we can detect it within 2 to 3 weeks, the 1st 15 to 21 days.

Some people divorce, they can detect it up to 11 days early, which is fine, well done. But what I say to you is, Make sure that if you don't see it 30 days before the last meeting, consider the examination equivocal. Before that it is quite small.

So it's easier, as I say here between 20 and 35 days post-breeding and I will personally say to you, make sure it's after 30 days. If we see it before 30 days, so we see the gestational sacs and everything, we are happy we can call it that is pregnant. If we don't, because it can be very small and moving and we may easily miss them, we will consider the exam equivocal and ask the animal to come back in.

In about 30 days after the last meeting, at which point usually gestational site is about 1.6 centimetres, so you will be able to see it. OK.

Now, the sensitivity of ultrasound for detecting pregnancy, that is quite high. What is quite risky is predicting the litre size. These little cuties, they have this habit of, you know, moving around and it's very, very easy to count them more than once.

You can try, but if we want to know. The number of puppies can be kind of more accurate, an X-ray at 45 days and count the heads and then usually use the term at least. So if you count, for example, 7 heads, you can say at least 7 puppies because on X-rays we may underestimate the number.

OK. Now, on ultrasound, I had the case. I remember in my youngest year when I was locumin that came as an emergency.

The owner. You know, that the animal had one puppy. But the owner was worried because 24 hours later with the animal, you know, the mother being fine, there was no other puppy coming and he was told there were 3 puppies.

So he came with the mother and the puppy, and he was like, oh, I expect 2 more, but nothing is happening, you know, my animal is fine, but I can't see any more puppies. I asked him how was the diagnosis of 3 puppies, and he told me by ultrasound. I asked him if he lost.

He said, no, I always watch the animal. There's no way we had the puppy somewhere else. So I said, OK, let's do a quick X-ray of the mother and see there were no more puppies.

So just to give you an idea that if you can count 3 times 1 puppy, you know. I will be very careful counting litre size on ultrasound. Now, ultrasound is great because I can see the philtre heart rate and I use the Doppler for example.

If I want to, to measure it, and it should be twice the maternal heart rate. Actually, the normal heart rate in the foetus is more than 220 beats per minute. OK.

Now, if it is less than 120 or we have excessive movement, so it moves like it's crazy, then we have to consider foetal stress and hypoxia. Now, if it is less than 160 beats per minute, then immediate intervention surgical is indicated to avoid, to prevent actually foetal death. So normally, more than 220, when it's less than 180, that means stress and hypoxia, if it is less than 160, then, you know, probably it's time to intervene surgically to avoid to, to prevent foetal death.

Now we can recognise the foetal structures and you can find tables like that. This is kind of, you can find it in papers like from Gigger that most adapted with other coauthors over there. And usually you can find in the papers like the ones by Dominic Fenning or, you know, Matto and Nyland that basically they have similar tables and you can have them around.

So when you have a pregnancy diagnosis, you can look. At it and usually you can see that for example, the station was sac appears 20 days after the post delay surge and the embryo will be seeing 23 to 25 days. We can see cardiac activity 23 to 25 days.

We can see the head and the body about 28 days and see the orientation. We can see the limb buds and the foetal movement by 35, the skeleton, you know, by 33 days. Usually between 33 and 39, you know, stomach and urinary bladder, 35 to 39, lungs, hyperechoic to the liver, 38 to 42, kidneys and sometimes we will see 39 to 47 days, post delays, cardiac chambers, 40, intestines, 50, 57 to 63, so they come near the, the end considering in though, it's about 65 days.

We consider the duration of the pregnancy. Now I have a colleague who's an excellent radiologist and a good friend and found the opportunity. One of our assistants, her dog named Zola actually was pregnant.

So, you know, Abby, Abby Doctor Abby King, which I will thank for the images I will show you. They are hers. Actually found the time to sit down and start scanning Zola's puppy.

So here is in day 24 and we can see actually the gestational sac and start the beginning of the foetus, this little thing in the middle. OK. Now, in the same, we can start seeing and that video hopefully will work and I will say, look in this area here when it starts working and you get this.

Heartbeat. You can kind of see it and so it's suspected, but I think looking at the colour and the beating, you can see this fast beating heart by day 24. OK.

I hope you can all see that. And then she went back to day 36 and then we could see already we can see the head on the right of the screen over here and we can probably take the other way around and You can actually see the heart, you can actually see the liver. You can start seeing the ribs, these bright lines over here at the top.

I hope you can see my marker, my pen over there. You can see this little bright dots that they come and you can see even the urinary bladder at the back. But clearly the heart now you start getting an idea of chambers in there.

You can see the head on the right hand side. OK, and, and below probably it's another foetus. Then she went back, you know, day 43, and suddenly we can see now, I will draw a little bit and then I will move the, you can see again the ribs.

That's how you should have seen them before and we will see now as it moves other organs when I figure out how to delete my pen. OK. Now, wish me luck.

Hopefully that will work. You can see again the heart, you can see the liver. Just to the left, as we look there as we scan through.

And we can see around the heart of the cardiac silhouette there, the ticking, you can see this lump, which is a little bit hyperchoic or wider to the liver, just behind the liver on the left hand side of the screen there is this little cutie moves around, we can see the stomach. OK, that was day 52. So, OK, we were well beyond the day 38 to 42, so we should have the lungs being hyperechoic to the liver.

Keep in mind, you know, the foetus hasn't breath, so we don't expect to see any air in there. Now, day 52, in this case, and we do the today is about the dog and the mating. Day 52 from last mating, we have the intestines visible according to the table here, it should be 57 to 63.

So OK, we have to take it with a bit of salt, the, you know, the number about there, we can actually see the intestines. Behind the liver. And we can see again the ribs and we can see the other foetus below.

And again On the same day, we can see actually the lens. And we can see the eye and you can create a lot of this, you know, 3D and 4D images that the owner so much like, but you don't really need yourself for your diagnosis. So having something like that, you can, you know, get it from any book, you know, and you can have it hang there and have a look at it when you look at the pregnant dog.

You know, there are similar we'll talk about later a bit forecasts a little bit and give an idea to the owner what to expect. You see, the semen of the dog will be viable for quite a few days. So effectively, the pregnancy, you know, the impregnation may happen up to 7 days after the last mating.

So when you calculate and you give an idea to the owner. They feel much better which week to wait. Of course, we have formulas to use for that.

And I, from all these, this is for the dogs here, we have other 4 cats. We can calculate the gestational age by using either the gestational sac diameter, crown ram length, or head diameter. This is for below 40 days of pregnancy.

These things, OK. The one I excessively used mainly in Sweden that they don't pay anything, was the top 16 times gestational sac diameter plus 20. OK.

And I use it mainly because I was having so many pregnancies. I felt a little bit bored. I thought I need something to try.

And although these come to + or minus 3 days. To my experience, the first one at least worked on the plus or minus one. So kind of start getting a reputation of calculating accurately the day of delivery which made things worse because most people wanted me to scan their animals.

But anyway, they, they seem to work and the easy way to go is you just measure the gestational sac diameter and you put it here and when you put it on that of that formula 6 times decisional diameter plus 20, it is estimated at 22.6 days. And at that stage, knowing the main thing of Zola, we knew that this one was 22 days.

Not bad, is it? So you see, not that much out. This, we knew it was 22.

The formula gave us 22.6. We can live with it.

Now, after 40 days, one that is very popular is 15 times the head diameter. You can see the, the, the head, and then we can measure the maximum diameter there. So 15 times that plus 20 centimetres, of course, OK?

And then The estimation here was 34 days. You can do it for me. 15 times 0.933 plus 20 came 34 days, maybe 0 something, OK, we are not that bad.

The actual we knew that in this case Uzola was 36, so we are within this plus or minus 3. So this kind of formulas can work for you also and to give you an idea. They may be plus or minus 3 days, but as I say, at least it gives you a week.

So the owners know that this is the week. I need to be more ready for the delivery. Now, when we come to the number of foetuses and I would like to thank Aigin for allowing me to use this image, you know, make an X-ray after 45 days and then just as you can see here, she actually has measured the skulls, 12345.

Actually, I think she had about 14 in the end, and quite a few and they were all born and they were all OK, fine. Very good puppies. Everybody was really, really impressed.

So if you want to know the number, take an x-ray after 4 to 5 days, calculate the skulls and give the number. And I usually say when you do that, use the term at least. OK.

Now, in the cat, yes, we have similar, not as detail in dog, you know, they have such a lot in cats. There are some studies. So the head and body will be seen about 19 to 20 days.

The heart can be seen by day 18, stomach by day 27, front and hind limbs by day 24. We can use the gestational sac diameter and crownum length before 30 days in cats. The one I have used.

It's mainly the one after 30 days that we use, we can use the head diameter and body diameter. I've used the head. So this formula is like 25 times the head diameter plus 3, and that is the gestational age plus or minus 2 days.

This is the one I've used. It, it worked pretty well. I can't complain, but of course, you know, that pregnancies evaluation and ultrasound are not as common as dog.

So, up to now, we talked a little bit about the ovaries. You remember in an it's a little bit tricky when we have follicular systems that are easier and we can follow them and we find them behind the kidney up to 2 centimetres. Now, we talked about the uterus and about fluid in the uterus, is the endometrial hyperplasia, kind of a precursor to pyometra, pregnancy, and then how we evaluate.

Some people, for example, pyometer for pregnancy, they like the animal to stand up, they don't like it on the side. So they use gravity to identify. You know, if that's what you like, that's fine.

I personally prefer to, to have the animal in a more controlled condition with the animal lying on the side comfortably, but you can do it standing, not as easy because I don't think all dogs they will stay, but depends on the individual animal, especially cats I doubt they will stay standing, but you can try and some people are very successful with that. Now, to kind of complete the reproduction, I will move now to the male and talk a little bit about the prostate. And the test is.

If you have any questions, you know, please put it on the chat. I will try to answer. I can promise I'll know all the answers.

So, prostate, it's a void and has a slight flattening on the dorsal surface and the one thing that People have not noticed this. They see the prostate, especially on the next page with the urethrogram, and they expect the, the urethra to just cross through the prostate just like that. They don't realise in here I will exaggerate a little bit, but it, it has a little bit of a more dorsal to the centre.

Boy, and they are not used to that. Then they go in practise, they do a urethrogram, suddenly they see that and they think that there is a big mass pushing the procedory slide mass. So keep in mind, urethra passes slightly dorsal to the centre of the gland.

Now, has well-defined margins. It's a little bit coarse, you know, it's like thick dots if you like. It's hypercord to the surrounding tissue and the size, we can evaluate it, but initially I recommend to people to use abdominal radiographs.

You remember? The, the prostate cannot be more than about 2/3 of the pelvic inlet if you like, if we count it from the sacral promontory to the pubic eminence. Now, after you scan the shoe, you start getting the juice of how big it should be roughly, and I, I really emphasise the roughly, you know, in, in small breeds, we're looking at about 2, 2.5 centimetres height, in medium breeds, about 30, medium sizes, in large, about 3.5.

Centimetres height, very rarely more than that. But as you scanning, using the X-rays to tell you about the size, then you will become more familiar. Now for the technique of the prostate, we do transabdominal imaging.

We don't do transrectal, OK. At least I don't like transrectal, though there are rectal probes and you can use it. More popular in humans, but I see over there now it also converts more to transabdominal.

OK. We find the prostate and we find the prostate using the bladder as a landmark. So we find the urinary bladder.

When I say bladder, I mean the urinary bladder, OK? We find the urinary bladder and then we slide cordially and we find the urinary bladder, so, like every other organ. Marker points to the head.

Locate caudally the urinary bladder and then slide caudally, find the bladder trigram beginning of the urethra, a little bit more caudally is the prostate. OK. Another way we can find the prostate is by finding the urinary bladder in transverse orientation with a marker pointing towards the spine and then slowly sliding and fanning our probe towards the hip joint.

That way, what you see is the bladder becoming smaller and smaller and smaller on the screen, then disappearing and then the prostate appears. And that's how we find it. OK.

Now, when we find the prostate, we can scan by finding dorsal and ventrally to go from edge to edge of the organ, and that way we can actually portray, I will show you an image with the urethra crossing and dividing kind of the two lobes and then rotate 90 degrees clockwise and doing it fine granually and cordially. Now, in younger animals could be very bad, very much in the pelvis, so you know. We may have a problem actually seeing it on ultrasound.

In that case, you may want an assistant to put a glove and push the prostate forward so we can actually examine it. Now, here's a normal prostate, one of the very few I've seen because usually when they are entire and they come, they are not exactly normal, but here you can see this ovoid appearance of the prostate. OK.

And you can see in this, we can measure the length, height and width depending on the orientation of the probe. I saw a query by Greg here. Is the butterfly Ave probe good enough for the first opinion practise?

I have been a vet for 40 years. I have never used ultrasound, but know when to refer or advise that ultrasound is necessary. I'm done with the idea of subscription to the butterfly system.

As have always been put off by the course of normal ultrasound probes. I have to disappoint you, Greg, I don't know the butterfly IQ system, so I can't, I can't really comment. If somebody from the participants here is aware of this, please leave a, a comment for, for Greg.

I, I don't know how this system works. So I can't really, answer, . I can't really answer the question.

OK. So if any of the participants know that system, please comment. But now I will make a note to go and find out the information myself about it.

OK. Sorry about that. So, What we look in the prostate?

We look if it is normal, which means hyperechoic kind of uniform, nothing too black or white, of course, we will have this coarse appearance like the big, big dots over there. And of course, OK, digital crisis is a problem from 0 to 10 megahertz. Yeah, usually in small animals, if it is a small curvilinear probe, you know, small footprint that will help in small animals, Greg, basically, that is fine.

The frequency, it's fine. If you have any problem between 0 and 10 megahertz, it's, you're fine frequency. Wise, because in a small dog, you will probably for prostate go above 8 megahertz.

In a large breed in a large breed dog, you may go even down to 5 megahertz. So the 0 to 10 is more than plenty. Next thing you need to look at is, is it a small footprint and then you can do the job.

OK, I hope, you know, about the probe frequency, I can comment on that, but the particular system, I do not know. Now, first of all, we look for prosatomega, which means the prostate is big. And as we said, initially using the X-ray scale, with practise, you will know it's big.

Here, this prostate is kind of more than 4.5 centimetres high. It is quite long also you can see that, so it is big.

Second question is, if it is big, is it uniform? And here it looks like it's uniform. I don't have anything bulging out.

And we can see immediately that there are small cystic lesions in. So big prostate, small cystic lesions and maybe bigger, you know, that's consistent with benign prostatic hyperplasia. But also we noticed something else.

There are more dark areas, more white areas, what we like to call myogenicity. So when we have a uniformly And last prostate with mixed ecogenicity. Usually the first thing we think of is inflammation like prostatitis.

Not that it cannot be a tumour, but when we're talking about tumour, we mostly expect something like a mass. So if it looks like a general myogenicity, then, you know, consider inflammation. That's another case of inflammation and here's the image I showed you that you can easily create that you have the urethra crossing through and you can see the one lobe of the prostate, which I know it's the left and the other lobe of the prostate that I know it's the right.

And I know that because I know that my probe has been placed from the left. Now look here, again, we can see the cyst. So hallelujah, benign prostatic hyperplasia, everybody happy but also again, I have a hypoechoic areas and more hyperechoic areas around.

So mixedogenicity again. So I'm thinking uniformlyas prostate, benign prostatic hyperplasia. I have to consider also prostatitis.

And usually with prostatitis maybe the sublumbar or maybe ilc lymph node. Depends how you would like to call it. It's a little bit on the chunky side.

OK. We may find cavity prostatic lesions, OK, like this one. And You know, you can see the prostate here with a humongous kind of irregular cavity lesion with ecogenic material in there.

That was abscess and you will say, how do I know that was an abscess? Simple. Put a needle in, drained, took pass back.

That makes it an abscess. If I took blood, it will be a hematoma. OK, so if I took just, you know, water fluid, that would be more like a cyst.

So there's no way by just looking at it. To tell you exactly what it is, I can put a needle and find out what it is. Here is another example of a prostate that is big.

Look at that, 4.4 centimetres in height, quite big, no matter what size of bread it was. And also it's myogenicity, so it looks like inflammation.

And of course, knowing that this prostate is big uniformly or myogenicity, so I start thinking prostatitis and I see this small cyst. My mind would mostly go to something like a an an abscess going on in there rather than something else because of all the other stuff I see in there. And usually with prostatides, you may have a little bit of fluid around the prostate, maybe the tissue around is a little bit hyperpo because of very prostatic inflammation.

So it's always good to look in those. Here, I have a, a lab that was a relatively recent case, a Labrador, 10 years old, that was neutered and we found the prostate, look at that. OK, small enough kind of in height, only 2.2 centimetres, probably not neutered very young, but also we have this bright hypeechoic areas with a little bit of shadowing in some of them which are consistent with mineralization.

And of course, you know better than I do that when we have a neutered male with mineralizations in the prostate, in a dog, we start thinking, oh, tumour. OK. And usually with Neuter dogs were thinking more of a transitional cell carcinoma, you know.

Neurothelium and ductal rather than an ocular epithelium neoplasia. Other tumours we can see also, you know, generally, not only with neutral dogs and adenocarcinomas and a differentiated carcinomas. This one was a confirmed transitional cell carcinoma.

How do I know? Guess how? We took an aspect, they confirmed it.

Here's another case of a confirmed carcinoma and we can see again, this prostate is a little bit on the chunky side. We can see it here. And we can see it has mixed and with hypoechoic areas, a little bit more hyperechoic areas.

It has mineralizations. And we can see again the same one clarifying another lesion. We can see the bladder here and we have these mineralized areas makes, makes us worried about the tumour and that was a confirmed carcinoma.

In this case also, in most of these tumour cases, looking at the mediaiac lymph nodes or, you know, a sublumbar, you can see that this lymph node is quite chunky. It's about 13 millimetres thick, and that is, that's really big, but also it's mixed ecogenistic for those who do not know the lymph nodes, that is kind of quite big and mix it's not this uniform appearance. So commonly we have met in the regional lymph nodes, especially.

The medial iliac. He's, I think, fresh from the press, as I say, this was a case which a couple of days ago. So don't quote me.

I don't really know what it is yet. We're waiting for the results, but we were scanning the bladder and suddenly, oops, not good. You can see the Foley catheter in the middle, with the, because it could not urinate, but you can clearly and that will go a little bit back.

The prostate is kind of myogenicity, quite big, irregular with this massy looking thing, and I will start again extending as you can see here into the urinary bladder triangle. So most likely tumour, we suspect prostatic origin going towards the bladder rather than the other way around since the majority of it is in the prostate, but we're still waiting for the results. So you can actually evaluate.

The prostate. Another thing we look for is called paraprostatic cysts. Usually, these are big.

They are usually next to the bladder, sometimes like here, they squeeze the bladder like there is no tomorrow, OK? And they can have ecogenic material like this one would set or they can be clear. This one, I remember the dog is was quite a few years back.

I don't remember the breed, but I remember that this guy will eat you alive if you went at the back end of the dog, OK? Then we drained it and this guy, which is after the drainage of the paraprostatic cyst, basically would be the loveliest animal you ever come across. Did we treat it?

Not really. It will be recreated if nothing else happens, but at least we release the pressure, we release the pain, if you like, we make it feel better, and then we can plan how we are going to treat with that. For those who don't remember, pararostatic is therefore to originate from the embryologic remnants of the mallenian ducts.

And or they consider extensions of a prostatic globe still on the theories. And of course, I will finish with the testicles. Which is something that we can examine if they're outside, and I will tell you how to look when we go inside, OK?

Now, usually I say to my residents, even if it is an abdomen and a male dog and the male dog is entire, always check the testicles. Why? Because usually, if there's something wrong with the prostate, there may be something wrong with the testicles and vice versa.

All I would say about the testicles is do not squeeze when you evaluate them, you know, it's quite uncomfortable. Secondarily, scanning them is more or less the same like the prostate, you know, fan up down, rotate 90 degrees, fan cranial quadra. I'm always a believer of double checking an organ.

The one thing I like about the testicles is that actually they have this bright line in the middle. So they tell you. Here I am, which is called the mediastinum testis.

When you see that, you know it's the testicle. When I look for a retained testicle because they are usually smaller, they may look like the lymph nodes. I'm looking for that line.

If I find that line, I know that the testicle is not a lymph node. So they are homogeneous, they are grainy, but very, very fine, like very thin dots. OK, we have this bright line, which is I mean this time test and that tells us I am the testicle.

You know, when we see it, we know that this thing is the testicle. And around the testicle, we can see the epididymis here, that's the head. The body will be somewhere here in the tail that we can follow, which is hypoechoic or if you like a little bit grayer to the testicles.

What can we see over there? We can see. Orchitis.

Usually when this acute orchitis. It's, it's considered most commonly to be seen as arsy hypoechoicogenesis, so kind of, you know, a little bit mixed but mainly darker and you can have the testicle and the epididium is being enlarged. Here, this one and you can see this testicle clearly does not look normal.

And you can see all these striations, hypoechoic, some small cyst, mysticogenicity. This came back as bio granulomatous orchitis. Torsion is another thing we expect to see.

And usually with torsion, we can see here the testicle between the callipers. The testicle is enlarged. Actually, you can see it's actually quite painful.

OK. The parenchyma is reduced in ecogenesis, so it's a little bit more hypoechoic and also the epididymis is enlarged. And the other thing, and we, we did also on this testing here, if you put the Doppler, you will find out there is no Doppler sign in there, so no blood.

We may find masses in the testicle and the reality of the matter is, by the appearance, it's not necessarily indicative of what it is. Three common types we see. We see interstitial, ladic cell, certoli cell and seminoma.

Now, this one that I show you now was or came back as a lady cell tumour. This one You know, came back as a certoli cell tumour, but, you know, by the appearance without doing anything else, it's kind of tricky to say what it is. Usually they are removed and sent for analysis.

You can always also do an aspect if you don't want the removal to find out. The retained testicle and here I have the me kind of to display the movement. When we look for a retained testicle and we have to do it for both here, we'll display the left, we'll do, and the dog over and do it for the right, or if you, if you put the dog on the back, you can check the left and the right.

Start from where you would expect to find the ovary, so behind the kidney because that's where the testicle will start and then move slowly. A little bit slower than that, called the ventrally going towards the scrotum and continue to pass through the bladder is him and then go to the scrotum. Of course, you can see the testicles in this dog, so the, this dog was not actually, this dog was not neutered or had any retained testicles, but this is kind of an idea of how you move to find the retained testicle.

Do you always find it? No, I'm afraid that's not the case. So if you don't find it, you still go on the next step and try to find it.

But if you find it, it makes things so much easier. And usually it's so superficial that after you can put your finger and feel the retained testicle. I had a case that the retained testicle was just before the scrotum, and I still remember that test was just before the scrotum and I couldn't hold myself, you know, you press a little bit, it went into the scrotum.

You took the pressure, it went back out. So it was quite a, a funny situation. So when I find something that looks like a testicle, that could be a lymph node, don't forget these guys can get malignantly transformed and, or if not, they can be quite atrophy, so it's not very easy to see them always.

But when you see them and you think, is this a retained testicle or a lymph node, what you can look for is this bright line in the middle, tin and testes. When you see that, you know that this is a retained testicle. Here is a newer one again, very similar location.

That's a very common location in the area of the, of the urinary bladder. And again, we can see the testicle. Actually, that was quite a chunky one to my surprise.

And then you can see this bright structure in the middle which is the maybe this time testes. So when you see that, you know what you're looking is the pained testicle. And both of these cases, you know, then we had to try.

So we put our finger on top and we could actually feel the retained testicle. I hope I didn't overrun too much and I hope I didn't tyre you. I know it was for you like everybody, a working day, so I appreciate your presence here and to those who will see the recording.

. That's all. I hope you got an idea of how to find the ovaries and the uterus, how to work about, how to work with pregnancy, and then how to deal with the prostate and get some idea of interpretation and with the testicles. Thank you and I'm open to any questions.

I don't know. I will put again my videos so you don't, you realise I'm, I am here. It is live, this recording.

So I don't know if anyone from the heroes that they're still present have any questions. Peter, thank you very much for that, very informative presentation. It's It, it, it's always logical when people like you demonstrate it and then fortunately, this has been recorded so we can go back and watch it over and over when we, when we battle with the technique to get your very simple and effective techniques working.

So thank you very much for your time. Thank you, Brose. And Greg, sorry, I don't know the particular system, but the frequencies you described before are fine.

Excellent. Well, thank you for answering those questions as we went along. And we are just on time to be finishing when we're supposed to.

So to all of our members that attended tonight and those that watch the recording, thank you very much to Amy, my controller in the background. Thank you and Pete for your time again tonight. Thank you so much.

Thank you for having me. Thanks, folks and good night. Good night.