Thank you very much and thank you everyone for listening. We're going to do a fairly swift, tour through ultrasound of the fall, and the first thing to say is that you don't need anything fancy to do a lot of what I'm showing you today. And fortunately, normal reproductive scanners.
Have a, linear probe on them which can do a lot of what, what I'm going to show you. Sometimes I'll show you stuff I've got with the sector probe, but you can still get diagnostic images with the linear probe. This is the machine I use, but you really don't need anything fancy to get a, a, a lot of these images.
So let's start with the thorax and all of the lung stuff really lends itself to using just a normal rectal scanner. So the lung field, all familiar with, it's roughly there. Pour a bunch of alcohol on the foal and put your probe orientated between the ribs along the intercostal space.
Go up and down and see what you see. So this is a normal lung field and This is the air, the pleura, this is, this bright line represents the air in the pleural surface of the lung. And it's important to know that anything you see below that first bright white line is an artefact.
We use these artefacts to help us know what's . Going on in the lungs, but they're artefacts, and we, we need to interpret them as such and bear in mind that they're artefacts. So, What happens is the ultrasound comes from the probe, hits this bright white line, which is the air, and reflects back to the ultrasound probe, and that is the way you get this bright white line.
However, because there's so much of the ultrasound waves reflected, they actually reflect back off the probe, and you get a second white line here, and that is called a reverberation artefact, and you can see you get some intermediate white lines in between, but As I said, that doesn't actually exist. It represents the ultrasound wave going back and forth twice and again. And again, So now if we look at this ultrasound loop, here is the lung, here is, the abdomen, and You just get a tiny impression of the diaphragm.
It's just there, at the interface between the thorax and the. Abdomen, but you don't see a lot of the diaphragm because it's under this air and the air is reflecting so much of the ultrasound that this isn't real. It's all this artefact and the diaphragm's running here.
So if you are seeing the diaphragm, there's actually something wrong with the, with the foal. Here's the classic thing that everyone thinks about when we're talking about thoracic ultrasound and folds. This is a large abscess.
Here, we've got our air interface either side and we have a large area of consolidation here. And what to notice is there's this broad comet tail underneath it. We'll go back to that in a minute, but this represents this, which is a large rhodococcus equi abscess, and they can be seen because a lot of them are at the plural surface, so there's no air over them and you're able, the ultrasound comes in.
And and sees this abscess and then it's reflected back from this. Surface where the air is at, at the base of the abscess. So here is another picture of a abscess within the lung.
Here you can see the bright white lines which are the reflective surface of the normal pleura and here in the, is the abscess, and here, this abscess maybe goes like this. Here you can see a broad comet tail, and the way this occurs is the ultrasound comes here and then it reflects, reflects here like a ping pong table, a pinball table reflects back and forth until it finally comes back up. And because each wave is going a different amount of times reflected differently between the different areas of this.
They're they're all reflected up and it creates this streak here which is called a, a comic tale. This doesn't exist. It's purely the reflections of the ultrasound back up to the probe, but it, it is good because when you're scanning quickly along the chest, often the broad comet tail is the first thing you find, and then you spend some time repositioning the probe and can see the abscess clearly.
Here's another one. This is quite a subtle little abscess because it's only just comes to the plural surface. Here's the plural surface here.
And again, the way I found this was I saw the comet tail and spent some time then on the area repositioning my probe until I saw the abscess underneath. So here you can see there's some. Fairly narrow, little comic tales, and you can see coming in and out is, a broad comic tale, .
And there, there it is. So this is the movie of that, Abscess that we looked at it in a bit of detail and it's really the wide comic tale that catches your eye when you're scanning for these. Here's another subtle one.
Again, it's really a, a, a very subtle little abscess up here, but it's the broad comic that gets your attention and helps you identify this abscess. Sometimes you see very narrow comet tails like shown here. This is just due to surface irregularities, so the same kind of process as I described for the bigger abscess also happens with the surface irregularity.
If the surface is irregular, it will bounce off at angles, it might bounce a bit and you get this narrow comet tail. This should not be confused for active abscesses and. Often if you just see a few comet tails, it could be a healed lung, narrow comet tails.
It, it, it may not represent pathology. It just represents unevenness of the plural surface, and certainly I would never treat an animal for rhodococcus based purely on the ultrasonographic appearance of narrow comet tails. There may be other signs, in the fall that make me treat it, but I would just purely based on the ultrasound of narrow comet tails, I definitely wouldn't treat it.
In the right ventral lung field, cranial ventral lung field, you occasionally see a couple of these narrow comic tails in 100% normal folds. So, so expect that in that location. This, however, is not normal.
So this is a huge number of little narrow comet tails and you can see actually an abscess coming in as well. And this is a very uneven, surface here with here, there was the abscess coming in. So, lots of comet tails like this, this density of comet tails gets my attention and then we have an abscess in here when, when I found it, and this again is a rhodococcus case.
This is a, a different, kind of appearance that we see, and this is an interstitial pneumonia. I call this a ground glass kind of appearance. It, it looks a bit like the non-s see through glass that you get in a bathroom window.
And this is through infiltration, throughout the, area of the lung that you're imaging here. Often this is viral. I, I see the symptoms with, HB 5 and other, viral infections of the lung, but it just Indicates, an interstitial pneumonia.
This is consolidation, and here you can see. This is the lung field here, this is the thorax, and here is the diaphragm. And we can see the diaphragm because there's no air in this area of the lung.
So this area of the lung is completely consolidated, has the appearance of soft tissue, and because there's no or very little air in it, we can see through it and here is the diaphragm. And then if we start the movie, we can see that here very, very consolidated, area and it looks, There's a few areas of air, the hyperchoic bubbles there. And then we come on to the diaphragm there.
This is sometimes referred to as hepatization of the lung, and that's a bit of a misleading term. What it means is that the lung has a similar appearance on ultrasound to the liver. It, it doesn't mean that there's any change to the lung.
That's related to the liver. It's just a way of describing the ultrasound appearance that the, appearance on ultrasounds is somewhat similar to the liver. Here is another area of consolidation and, and in this example, I, I'll let the, here's the diaphragm here.
And, and here's an abscess here with hyperchoic content. There's normal lung there and as we slide down to the ventral area here. Is the ventral area, his, spleen here and some gut here.
Here is the diaphragm here, which you shouldn't be seeing, and this area here is consolidated and has no air within it, and that's why we can image the diaphragm beneath it. And here this area is his normal lung again and this area is reminiscent of an abscess. With that very hyperchoic centre to the abscess, I would be concerned about anaerobic processes there and that would make me consider treatment for anaerobic bacteria such as metronidazole.
Here's, a beautiful little picture of consolidated lung, within pleural fluids. And so what we have here is, here is the, Intercostal muscles here is the Here is the lung here with the tip of the lung. It's consolidated, so you can see through it again, maybe has the ultrasonographic appearance similar to liver here.
Here's the tip flipping in the fluid. Here is the diaphragm, and this is quite ecogenic fluids here. So this is a pleural pneumonia in a foal.
It's not that common to see pleural pneumonia in foals compared to adult horses, but it does occur. This was a foe that was about 6 weeks old and had a, a strep zoo pleural pneumonia. We, we tapped this and we're able to drain off the The fluid and as suggested by the ecogenicity here, it was, it, it, it was paraent material.
It wasn't a pure liquid, there was quite a lot of white cells in it. It was quite paraent material that we drained off here. So this is sometimes a challenging thing to diagnose on.
In a, in a animal, and so this is probably worth spending a little bit of time on, it's not looping for some reason, so. What we're looking at here is this is the thorax. We are dorsal in the thorax and we're looking at, this is dorsal and this is ventral.
And so we have what looks like lung at first look over this side, but it's not actually moving. And then as we go ventrally we can see this area here which is moving in and out of frame and again has a highly reflective surface. This is a pneumothorax, so here dorsally, we have air and it doesn't move with respiration.
And then here ventrally, we have the lung, the dorsal surface of the lung coming in and out of, of this image with respiration. So the way I obtain these is go very dorsally on, on the, thorax, have a look and there's non-moving, reflective. Air there that doesn't move with the respiration and then you keep coming down and when you see this interface between lung and air, you can be certain that that's what you're seeing and it's a pneumothorax.
So again, this is dorsal this side and ventral this side. So another thing that ultrasound is very useful for and and usually better than radiography is looking at the ribs and so this is the rib here. So this is taken the same way as we talked about previously, except for you have your probe, you have it between the rib spaces, and then you just orientate it alongside the rib between the rib spaces, and then you just slide it onto a rib.
Here we actually have the costrachondral junction. And this is a normal rib. Here we have again longitudinally .
Here is the the surface, the lateral surface of the rib, and here is a fracture. And what we can see is here into the muscle, overlying the rib, there's a small haemorrhage into the tissue over it, which is what this area represents, and this is the fractured rib here. So we've got normal looking rib here, just a, a bright straight white line, and then we have a break in the rib.
Here's the coststrochondral junction here, and we, we have a fractured rib and as I say, it's actually easier to detect fractured ribs, usually with ultrasound. Than it is with radiography because with radiography, everything overlies each other and it can be very difficult to be certain that there's a fracture, especially if they're non-displaced. Here is a video loop of a similar.
Situation here's the costochondral junction here. Here is the, And, dorsal, this is dorsal, this is ventral here along the rib and you can see the fracture in this space here. So.
Just move the probe alongside this. And this is, as you can see, this is in a quite an important clinically fractured rib for this fall because it's just overlies the heart. You can see the heart beating underneath.
If this fractured piece is displaced, . Immediately, then you can puncture the ventricle and I've seen falls die because of punctured ventricle secondary to fractured ribs. This is an old fractured rib in this thorax and so in this picture, and here is callous formation on the surface of the rib.
So this is the uneven callous formation at the site of the fracture in this rib. This is a displaced fractured rib with some callus there as well, so. Yeah.
Here's the rib here. There's some displacement here and then we go and have a look at the Callous in this fractured area in this next rib here. One differential for low red cells, some jaundice in a young pole is actually fractured ribs, and this is why they can lacerate the blood vessels around the ribs or, as I said, the ventricle of the heart.
And this is within the plural space. This is haemorrhaged within the plural space here. So usually, I will quickly put an ultrasound on the thorax of a fold that presents a suspected neonatal lyertholysis just to check that there isn't a hemothorax there because it's a rare differential, but it does occur.
Fractured ribs themselves are very common. They occur as part of the birth process, the trauma within the pelvic canal. Often if there's a leg back, the elbow will get pushed into the rib cage, but it can occur in births which are apparently non-traumatic and really easy births, and, and still you find some fractured ribs.
If they're in 34, and 5, they overlay the heart and are clinically significant. Often those need to be plated or caged wired in place. If they're further back, then usually they are left alone.
So this, you can get an impression of these. With the erectal scanner, but this is the one thing in the thorax that it's good to have a sector scanner for and this is the heart. What we have here is the intraventricular septum.
This is the intraventricular septum here. This is the left ventricular outflow tract, aortic sinus, aortic valve somewhere here, and here we have a ventricular septal defect. Here's a colour Doppler of a ventricular septal defect.
Again, we have the aorta here, left ventricular outflow tract. This is the intraventricular septum. This is the The commonplace for them and that's why you can sometimes pick them up with just a linear scanner because you can look for a hole in this area.
It's just below the aortic valve in the ventricular septum, and here you can see with the colour flow we can prove that there's flow across there and it's definitely a ventricular septal defect. This is just a hey wow, we won't spend much time on it, but this is the left side, right side of the heart, here's the aorta, here's the intraventricular septum, and we have dextro position, we have ventricular septal defects and, dextro position of the aorta here, which is part of the tetralogy of yo. Can also pick up .
Other things, when other congenital, abnormalities when, ultrasounding the heart, one that is pretty common in falls less than a month and, is naturally heals up or naturally closes is the ductus arteriosis. You can often hear a murmur associated with the ducts arteriosis in very young vols. And it will heal, heal up.
It is If, if there is a patent arteriosis, you can reduce the pressure in the pulmonary circulation by giving the al sildenafil, which is more famous as Viagra, that reduces the blood pressure within the pulmonary circulation and may help, a doctor's arteriosis close up. So that was a quick gallop through the thorax, and now we'll have a look at the abdomen. We'll start with ET and this is the internal umbilical structures.
So here we have the We're absolutely midline. Again, this can easily be done with a rectal scanner. Here is the rectus abdominal muscle.
Here is the linear alba, and we are just caudal to the umbilical stump. So we've got the probe positions at across the fall, 90 degrees across the fall, and we're just behind the umbilical stump here. These are the internal umbilical structures.
This is the internal umbilicus. This is the left and right, internal umbilical arteries, and this is the Eachus and as you can see, it looks a lot like ET. He's the neck of ET and here's the head of ET.
So that the umbilical arteries and the urachus. Here, the umbilical arteries, go. Go cordially and come alongside the bladder on either side, and they become after the blood supply has, after the blood supply is cut off after birth, they end up becoming the round ligaments of the bladder.
So they run, as I say again, we're, we're now further causal. This is the bladder wall. This is the bladder here and this is one of the umbilical arteries in the just alongside the wall of the bladder.
If I played the movie, you can see here's that umbilical. This is the bladder, it's pretty full in this bowl. There's one umbilical artery here and There's some gut.
Here's the other umbilical artery here. These are normal here, there's one there, there's one there. The umbilical artery split and go either side of the bladder as we go quarterly.
This is the umbilical vein. Again, we have the rectus abdominal muscles, the linear alba, and here, Is the umbilical vein. It's smaller than the umbilical arteries up to a maximum of 6 millimetres.
The umbilical arteries go 8 to 14 millimetres maximum, usually for umbilical. Arteries we say less than 1 centimetre diameter is normal. These are centimetre marks here, so you can see this is much less than 1 centimetre.
For the umbilical vein are up to 6 millimetres in diameter, and it can be quite subtle to find, but it's dead on midline. And some other species carves it, it's lateral to midline, but in voles, it's dead on midline and it so we're here we are. Just cranial to the umbilical stump.
The umbilical vein runs cranial all the way to the liver and then disappears into the liver, and it, after the blood supply is gone, it becomes the falciform ligament of the liver. So there we have the rectus abdominal muscles and the umbilical vein. Why do we care about these structures?
Well, we care in case they get infected, and you can often see infection in these, structures ultrasonographically. So here again we have the rectus abdominal muscles, linear alba. This is going cranially just as the, umbilical vein is there coming off the body wall.
Here is the umbilical vein. Here and it's very enlarged with a hypoechoic centre and this is an omphallophlebitis, which is just the posh way of saying infection in the umbilical vein. This is actually looks like an abscess within the umbilical vein and this was treated with antibiotics.
I believe this one didn't actually respond and was treated surgically. We treat far fewer of them surgically than when I started out as a, in the early 90s or late 90s, we were cutting out lots and lots of umbilicuses and then we realised that that's not without consequence. You can get adhesions and other issues down the line from from the surgery and so take a much more conservative approach now.
Treat with antimicrobials, but usually something that penetrates really well, doxycycline, Singulox, fluorenacol. And, monitor temperature, monitor the size of the internal umbilical structures, and only go to surgery if, if, if there's a problem. This is the bladder of a foal, and this is found about 2 to 3 centimetres behind the umbilical stump.
If you're in a cotfo, you place your probe just cranial to the sheath, and there you can usually see the bladder. And this is what we're looking for. Usually the, the number one thing we're trying to work out with the bladder is, is the bladder intact or not?
So in this case we have here rectus abdominal muscles, here is the linear alba. Here is the bladder, and what you can see is that it is collapsed, is the umbilical artery and that around the bladder, free in the abdomen, is a lot of hypoechoic fluid. So when I'm looking to see if I have a ruptured bladder, I look for two things.
One is The hypoechoic fluids within the abdomen and the other is, is the bladder small and collapsed? Here's another . Image of a different foal with a Bladder rupture.
Here we have linear alba. Here is the bladder. And here is lots of free fluid around it.
If you look here, there. I'll try and leave the. Arrow in the right place.
It's a bit of a moving target there you can actually see the tear in the, in the bladder. Most bladder tears are dorsal, a few are ventral, but the majority are are dorsal. This is another bladder and this is something that we occasionally see, which is, here's the bladder and there's this.
Moderately achoic, . Structure within it, and this is a clot. So this is haemorrhage into the bladder.
This seems to occur when there is trauma to the umbilicus as the fo is being born and there's bleeding into the bladder. Here's another one. Here is a clot with a bit of, probable calcification in, the, within the clot.
Within the bladder walls. So in Philies with this, we have simply flushed the bladder. And here This Billy was able to pass the clots, and this was the clot that we were imaging there within the bladder.
This is also a case where the umbilical stalk as it, as it entered through the body was traumatised and unfortunately this one didn't bleed much into the bladder. It bled into the abdomen around it, so this hypoechoic fluid around this damaged bladder, which seems to have a bit of a hematoma in there, is blood, and so this vol has a hemoabdomen and hematoma in the internal umbilical stalk. Let's talk a little bit about colic in the fall, ultrasounds very useful for colic.
In a fold that is less than 36 hours old and has, is colicing, the number one differential is usually meconium inaction. I encourage everyone to perform a one finger rectal, in, in such folds with a glove looped hand because you can often feel the meconium in the rectum and that, can give you enough of a diagnosis to, try, try. Enemas prior to worrying about ultrasounds or anything else.
Meconium has a very distinctive appearance on ultrasound. So this is meconium with higher up in the intestine, . And This is the appearance of meconium.
So it's a very speckled appearance. You usually get a kind of roundish appearance, and then this very speckled appearance, and that's what meconium looks like. So often in these animals, especially if the meconium, it's a high meconium impaction, you can use ultrasound to find the meconium higher up in the abdomen and you can image it with ultrasound.
When we're talking about falls with colic, one of the things we are trying to do is determine is this a surgical colic. We all know the things that we try and Look at in Adult horses, and these have been adapted for falls by simply changing the heart rate. So in adult horses we talk about heart rate over 60 and people have just simply adapted this and put heart rate over 115 as the parameter for falls.
Also, no response to painkillers, no gastrointestinal sounds and reflux on gastrointestinal intubation. However, We've got huge amounts of good data in horse in adult horses. To determine that these are the signs of surgical colic.
In folds, we've got much less data. We looked at 47 folds which either were surgical or medical and we compared heart rate, respiratory rate, temperature, Pain and, and ultrasound finding. And what you can see here is there's very little difference in heart rate between surgical and medical cases.
Surgical cases had a slightly higher respiratory rate on average, but if you look at the ranges, there's big overlap between surgical and medical cases, and I would hesitate to pick out surgical and medical cases based on respiratory rate. Temperatures no different. Colicking at admission.
Surgical cases are more likely to be painful at admission than medical cases, at least in this case series. But Only 61% of surgical cases and were colicing and fully 30% of medical cases were colicing at admission. So again, it's pretty hard to Call Out which of which based on pain alone and ultrasound findings was the single best factor at determining which were surgical and which were medical.
Again, it was not perfect, but a positive finding on an out sound is this is the most useful factor for distinguishing surgical and medical colics in young foals. So let's look at some of those positive ultrasound findings, and have a look what we can see with our ultrasounds. So this is pretty normal intestine.
We've got, progressive bboygma, in a mature adult horses, often you can't see the small intestine. Usually you can find some small intestine in foals and there's fluid within the lumen, and you can see it contracting away there. Here we have And another fold and there is a bit of increased peritoneal fluids here.
There are these loops which are pretty turgid and they are not, they seem to be moving more with respiration than any progressive peristalsis. And they, although if you measure it, the wall is not very thickened subjectively, it looks like maybe a small bit of thickening of the wall. And this I would call as a twisted small intestine and I would call it a surgical colic.
And this indeed is the same for . Half an hour later at, at surgery, and this was a small intestinal volvulus. What about this one?
And this is trying to show you that there's some subtlety involved. So these are very full, . Loops of small intestine, but there is a little motility here and the wall is less subjectively thick.
There's also maybe some gas in in the intestinal wall here. This is dorsal intestinal wall is hyperchoic. And this is an enterocolitis.
So You you need to spend some time looking at it. It's not 100% straightforward. Put the probe on no in 2 seconds whether it's a vulus or an enterocolitis.
It can. There are differences, clear differences between them. There is some intestinal movements here.
There are some collapsed loops here. But there's clearly some hypomotility here because there's some settling out of contents. This is ventral, remember, so this is settling out of content.
So It does take a little while to get your eye in between which is surgical and which is an enterocolitis. Here's a different surgical lesion or a different lesion, and, I want you to, I'm going to give you a minute or two to look at this before I tell you what, what's here. OK, so again, this is ventral.
This is the umbilical vein, rectus abdominal muscles, linear alba. Here is a loop of hypomotile or non-motile small intestine. You can see the contents, settling out, but the real lesion is here and this is an interception.
So this is a classic target lesion for the, for an interception. Usually, These are heavy and so they fall down to the ventral midline and I would say if you're scanning a false abdomen, always stand it up and scan a vent. The Within a normal standard and down.
Here is another, interception. This is more, classic in that it's on the ventral body wall and here are the, layers of intestine here. 123.
This is the same fall a few hours later or part, the same part of the fall a few hours later, taken out at surgery. Here is the interception. Here you can see it, telescoping in.
And here you can see that the area that was intercepted is very compromised and the, the blood supply was extremely compromised to the area that was intercepted. This is another interception, but this is a psycho colic intersception in a yearling. Here you can see.
Again, here if I play the loop, here are the layers here. Of the secum here within the colon here. This is in a rising yearling.
One thing that is putting in the literature as a way of determining. Surgical lesions. If there are two populations of small intestine, and what that means is that There's some areas of collapsed, small intestine like this.
There's no, no, contents in the middle of it. This is the mesenteric stalk here. This is the collapsed small intestine and some areas of dilated small intestine.
So if we look at that. We can see. Here's the collapsed small intestine and here is the dilated small intestine.
Don't rely on this as a sign of a surgical lesion. This one is actually an enterocolitis and peritonitis, a segmental enterocolitis, enteritis, and, peritonitis. So, Usually, that's a sign of a surgical lesion, but it's not 100%.
Here's a little case, 4 day old fall with colic, acute colic earlier in the day, little response to analgesia presented with a heart rate of 120, respiratory rate of 50, no reflux, not currently colicky. Here's the foal. Here is what we see in the ventral abdomen, and you can see there is the spleen, here is intestine, there's motility of the intestine.
What you notice though is that it's the re rate respiratory rate is actually quite fast and this just shows you not only to look at the ventral abdomen. Here is the right side, at the diaphragm. Here's the abdomen.
Here is Reasonably normal looking lung. This is the left side. And here is the diaphragm here.
This is the abdomen and this is the thorax, and here are loops of small intestine within the thorax. We play another loop here. You can see the lung here and you can actually see this loop of small intestine just coming out from under this .
Under the lung there, there. So this is a diaphragmatic hernia. This is what it looked like on radiograph.
Here is it at surgery and there's the intestine entering through the diaphragm there. And here's the repair done at surgery. Enricolitis is one of the most common things we see, and if you see blood in the stool like this, it's often a, I'd be highly suspicious of clostridial enteritis.
If I see this, I'd immediately treat with metronidazole prior to any further diagnostics. On ultrasound, what you see is gas bubbles within the intestinal wall. And again, this is a sign of anaerobic infection, frequently clostridial infection.
Here's another example you can see these little. Hyperchoic dots here on the intestinal wall, hyperchoic area here and here, and these hyperchoic dots on the intestinal wall, this is another clostridial diarrhoea. Sometimes the gas production by the bacteria is very large indeed, and you can get massive gas production in the intestines, push on the caudal vena cava and diaphragm and abdominal compartment syndrome, and some of these folds can die simply from having so much expansion of their abdomen.
Here is another case. This is a ruptured stomach, and you can see the peritonitis here. They're very thickened small intestinal wall and this very hyperchoic peritoneal fluid.
This is a faecal peritonitis through a small colon, . Rupture it's actually caused by the ovary wrapping around the small colon in this pole. I don't know how they managed to do it, but they do.
And so you can see this very hyperchoic faecal material around this inflamed intestine here. So there's a very enlarged stomach of a foal. Here's the, spleen, stomach, and here this is on the left side and here is the lung.
And that can occur secondary to gastric outflow obstructions or duodenal stretches. When we're looking for the duodenum, it's just off the right cranial pole of the kidney. Sorry, that didn't play.
Here we go. So here is the kidney and here is the duodenum. So this is just, find the right kidney and then you find the duodenum just off the right cranial pole.
Of the kidney here and that's again, we're using a linear probe and, and there's the normal duodenum. Here is a thickened duodenum, secondary to duodenal ulceration. This is associated with a large stomach like the one we saw before.
You can see the thickened duodenal wall here again, kidney. Right to colon and here's the duodenum here. This is Here the duodenum courses cranially and goes just ventral to the liver, right dorsal colon here, liver here, and here is very thickened duodenum, should be less than 0.3 millimetres, 0.3 centimetres, 3 millimetres, and here we have a very thickened duodenum, just just medial to the liver.
Talking thick guts, sometimes we see falls, weanling falls with marked ventral edoema. And one of the differentials for that is Lawsonia. These folds end up with very thickened intestine and often you can see the layers of the Intestinal wall because there's edoema within the intestinal wall.
So these are cases of Lawsonia Intracellularis and it's quite hard to diagnose by the lab. There are lab tests available, but often we suspect it on ultrasounds and start treating with, tetracyclines, oxy tetracycline. Doxycycline or the macrolides based on ultrasonographic appearance of thick and small intestine, very low protein on biochemistry.
Plus or minus some, ventral edoema. There's another example here. Yeah, this is again the duodenum here.
Here's a foe with a very thin neck, slightly older fo, slightly pendulous abdomen. If you put the fall up on its back, you can see that there's actually a bump here. And this is a very large rhodococcus abscess.
If you look at the depth here, this is 25 centimetres. So this is an intraabdominal rhodococcus abscess of about 20 centimetres in diameter. You can see the wall of the abscess here and the slightly lesserchoic material within the abscess.
There's another example, slightly lesserchoic here, and you can see this, this is a smaller abscess here. This is what it looks like at postmortem. Liver Liver, don't see many issues with the liver.
This is a strange case where this pole had a lot of intravascular hemolysis and the iron within the intravascular hemolysis was scavenged by the liver and gave this strange appearance. I haven't really seen this since, and the fole showed, showed no real signs or clinically associated with this. Kidney Normal kidney you see cortex, medulla pelvis, the medulla should be less ecogenic than the cortex.
Here is a case of acute renal failure. Here you can see the pelvis. He often there's very subtle increases or in ecogenicity in the medulla.
Sometimes you see nothing at all on ultrasounds in acute renal failure, there's a chronic renal failure, much more ecogenic in the medulla of the kidney and loss of contrast between the cortex and the medulla. Here is another one, and we just have an increase in size in the kidney and an appearance may be of increased ecogenicity, but the main thing is that the, the whole kidney is swollen and increased in size. Here's that fall receiving peritoneal dialysis.
It's a different fold. Also, here's the ingress and here's the aggress, giving peritoneal dialysis to that fall. Here is a Cystic kidney, it's a Congenital defect faulted fine, it's just seen sometimes in the kidney.
And then having trotted very fast through the abdomen, we're going to spend 2 minutes on other things we can ultrasound. This is a fall which presented after dystopia and a lot of effort to get it out. You can see very large swelling.
Here, this is a . A tear in the muscle, ruptured Achilles, and, here you can see the disrupted muscle fibres, a lot of haemorrhage within in the muscle body. In these Ruptures in the causal aspect, casting them can help them.
This fall did well, became a stallion, did not race but was well enough bred to become a stallion. There are reports from Kentucky of good athletic outcomes. It depends on the degree of damage and, and how quickly it's addressed.
Basically, we are. Casting it to prevent further trauma to this, muscle with the with the hock bending. This is the opposite.
This is swelling in the quadriceps. And this you can see the quadriceps muscles surrounded by haemorrhage here in the muscle belly. Here is the full cast and This file was put down when I saw this here is complete failure of standing.
So the, the hock is straight in this cast and the stifle is still bent and horrible, horrible. You can sometimes see increased synovial fluids, so P2, P3, this is an old one from where my residency at Marion DuPont, and there is the increased gap between the, in the coffin joints. Here you can sometimes see lesions on the bone.
I don't often use ultrasound for this purpose, but it's possible to see osteomyelitis with ultrasound in some cases. I think Eddie Coman actually took this ultrasound. And here's just one last case showing you the utility of ultrasounds.
Here's a fault that's lame with a swollen hock. Here is the ultrasound and it shows you that it is all extra synovial. Here is an abscess on top of the synovial surfaces.
So. Had you tried to tap this joint to see if it was a septic joint, you would have introduced infection into the joint. By use of ultrasound, we were able to determine that it was all extra synovial and just strain the abscessor and the fall was much happier once it could bend its leg without impinging on that abscess.
Just another thing that we sometimes see in folds, this is a foreign body, it's a microchip. And so this is an abscess around the microchip in a fold. Not, not that common to see microchip related abscesses, but, you, you can sometimes see them and you need to remove the microchip for the abscess to heal.
So Full season is very busy, very important to multitask. This is a, Katherine Herron, multitasking, during the season. These are some of the apps we've produced.
You may be familiar with equine drugs, techniques, lab, and joint injections. These have been rebadged by Beaver for their members. They're also available to purchase from the App Store.
We also have radiography app with labelled, pictures, dermatology, which takes you through lots of different dermatology conditions with lots of photos written by Sue Patterson. And two excellent ultrasound apps, advanced equine reproductive ultrasound, for example, shows you how to do foetal sexing in falls. That's a book I wrote a while ago.
Thank you very much. Thanks Kevin, that was great, . Love those apps, I think they can be really useful.
So just if anybody wants to find those, they'll find them presumably in Google or in Apple will they app store. So, there's the full range in the Apple App Store. You search under either veterinary advances or, due to a little quirk on Apple's rules, the drugs one is actually under Sycamore Lodge equine Hospital because You have to be a hospital to have a app that lists drugs.
So, . The, and in Google Play, they're under, veterinary advances, but there's more limited range because fewer fewer vets actually have Androids at the moment. So yeah, do go and have a look at those.
Are there any questions, and in fact if you're struggling with the app, I'm sure you could fire Kevin a a quick email as well. Any questions, fascinating area, Kevin, and I loved all of the, the ultrasounds, how clear they are. I was .
A dermatologist when I was practising, that's a lot easier than doing ultrasound because you can see everything with your own eyes. So I have great admiration for people who can see detail in a snowstorm. Sometimes it is a bit like clouds on a psychiatrist chair, but No, that was excellent.
So I don't think we've got any questions. Presumably, just, those of you listening in, do you, do you all use ultrasound in in horses? Is that helpful of those pictures being helpful, perhaps just a little bit of feedback to make sure we're on the right lines.
It's certainly, you know, looked very good. To me, but you know, it'd be interesting if you are seeing horses, whether you are doing any ultrasound. Yourselves, so feel free to just tap in at maybe into the question and answer or the chat box, if you are, if you are doing a bit of ultrasound in your equine practise, I'm sure.
You are, but if that was helpful or not. Let's see if anybody wants to to answer any of that. Just tell me a little bit about this Larson, cos it it's not something I've heard of a great deal before.
There's Lawsonia in pigs, but I don't think it's, it's related to them, is it? It, it is and it isn't, so . It is Lawson intracellularis, but there are species-specific strains of it.
It actually was first discovered on in horses that were on a pig farmer. And I guess that's how it was found. Oh, Kevin, I think you've just moved your microphone.
It was, yeah, that's better. Sorry, sorry, I was saying it was actually found on horses that were in a, in a pig farm and I guess that's how it was discovered that it was. You know, that it was Slausonia in the horses, yes.
And it's a disease of weanlings usually associated with the stress of weaning weaning, typically occurs about a month after weaning but can occur any time. The peak months are September to February, and, we don't actually know the vectors for foals. There, there's different papers on which animals might carry it, .
Rabbits, cats, and deer have been implicated. And there are other papers saying, well, maybe it, it's not in the, the rabbit one can't go to, or the deer one can't, can't go to als, so we're still learning about it. But it does cause a proliferative enteropathy, and, massive weight loss like in pigs.
Do you think this is is it becoming more common or is it just being diagnosed now? It's being diagnosed now. I think there's a lot of subclinical cases which it's in weanlings.
People think it's, rhodococcus because the, the false just got a steri coat or something, treats it with macrolides and macrolides are effective. So, I, I think a lot of it goes under the radar that way. That's great, Kevin, just wanted to thank Bailey's Horse Feed who've been sponsoring this series.
So, obviously, thank you so much to Bailey's for, for making this possible. And Kevin, as always, I always, I always enjoy listening to you. I'm not a horse vet.
I did a bit of horsework early on in my career, but it's a, it's a fascinating area that foe medicine, and you've really brought it alive for us tonight, so. Thank you so much. Thank you very much, Antony.
Thank you, Kevin. Take care, bye bye everyone, see you on the next one in a month's time. Bye bye.
Bye then.
