Lovely, and welcome to our webinar today on avian radiography. What we're gonna do is go through a lot of the basics, from taking the radiograph through to interpreting it. And here's the big thing.
What does radiography show us? Well, obviously we know from basically every other species, it'll show us air. It'll show us hard tissue like bone, and it'll show us a lot of grey stuff in the middle, which is a soft, soft tissue.
And that's great. So it shows an awful, awful lot, and we use it loads, in, . In non bird species, in birds, they're potentially even more use, which I'm hoping to show you.
So actually there's a huge argument that you can use radiography in almost every single case, and probably that's what we near enough do. We probably image more cases than we actually take bloods from and that kind of thing because it shows so much information. So what do we actually need?
Well, do you know, avian radiography needs exactly the same as you need for everything else. We need an X-ray generator, we need an image plate, the same developer, it could be, could be old fashioned use, plate developers, I date back to using, developing tanks in a, in a very cold darkroom, through to automatic processes and now Fortune onto digital, which is a lot less hard work and gives much better, more consistent results. But there are CR systems, there are DR systems.
That's great. Whichever you use those same principles, the kilovolts, which are the amount of penetration versus the milliamp second, which is the basic amount of a rate you're gonna produce and therefore the amount of contrast you're going to get. If you vary your time a milliams separately, that's brilliant, but most machines will tend to simply vary the time.
And so therefore you have to build into factors like movement blur and that kind of stuff with each development. So know your machine, know what it produces, know how it produces it, and that's gonna help you develop your own techniques with that. And that's really important because although you can take some guideline exposures and things, each machine has a slight little variation.
Definite make has a big variation. So you need to build up your own little portfolio of what settings work for you on your machine with your species range and stuff. And these are quite small, so you can make a lot of difference and very small changes.
Positioning is critical, the old plonk on a plate. Is almost always useless. Birds have got lots of limbs, the wings, the legs, they all go across stuff, and if they are simply in the way of the body parts, you're not gonna see a lot.
And to be honest, it's probably better not to do an X-ray than do a badly positioned one. You can do some conscious positioning. The restrainted devices are available, particularly on the continent.
You can occasionally you'll see a picture of manual holding, in this talk. UK law basically is very much along the lines of you can't do that, and this is absolutely no alternative. And I think that's a good position to be in.
X-rays can be harmful. You do need to protect yourself. You should be always covering up and things and wherever possible, not doing manual restraint.
And there are very few times you genuinely, genuine need to do that too. So that's important. Now, the other thing is, if anyone's been for an X-ray, they'll know that you get told to stand this way, that way, put your shoulders back, do this, do that, and you can be told to do that.
Birds obviously don't do that. So therefore, you're gonna need some kind of chemical restraint, whether it be a full anaesthesia or sedation. Which you do, depends very much on probably how painful bit your moving is, how much you need to stretch wings, out.
A lot of birds don't like having their wings stretched out, so sedation may not be enough, but we will sometimes use intranasal, midazolam, buil combinations. Most of the time we'll probably use just straightforward isoflurane. And we have to prepare them for that and make sure they're actually ready and then no crops are empty and that kind of stuff before we can go ahead normally.
It is important to starve them beforehand, particularly in body X-rays. These are raptors, and if we do have very full stomachs here, we can see the skeleton of the prey, in this case they'll chick inside the stomach. And what it's doing is filling up all this space in here, and that's making it much harder to interpret.
Always take at least two views, take those 9 to the orthogonal views, because otherwise you're never quite sure what's artefact, what's where, and try and build a 3D picture from there. So these are our standard views. This is vented dorsal, the birds anaesthetized, we have the legs pulled downwards, we have the wings pulled outwards, try and get them as symmetrical as possible and we're positioning, the cross on the body.
And for the lateral view, again, we're gonna really on our left or right side doesn't really matter too much which. You're gonna pull the legs backwards. Occasionally for certain views, you might pull it forwards, but that depends really what you're after.
Most time you pull them backwards together, and the wings go up above the body together. This is it which really can go wrong. If an old cage b birds in particular often have quite fibrose joints, they do not like that stretch.
They're a bit light. You may sometimes get them fighting it. If they're doing that, just get a little bit deeper.
Don't fight that, don't make them hold the wings up there. Sometimes they'll actually flap against that and actually break the humeri. And it can happen, I've seen it happen.
So just be careful when you're doing that. If you've got a lot of resistance to the joints, do it very, very carefully. But you do need them out of the way, otherwise they sit sit down across the body.
You can do 90 degrees, you're doing things like wings and stuff. So for example, here's a kite where, where is, wing injury, and this is the ventral standard ventral dorsal view, but we'll have a bit more in detail, so we're doing a hold, trying to do, a, a, a, cranio cordal view. My fingers would not be exposed in this normally, we'd actually slide above there's just showing where we're holding.
But we're holding above there. But one of the good things this does is it actually gives a bit of magnification. So, the the gap between the target site and the image plate, the bigger that is, the more magnification you'll get.
And that can be useful occasionally. These days is how we would do it. We actually we'll position the wing out, and just use tapes and sandbags, and we actually hold the wing outwards, without actually holding it manually.
So we get this magnification, but actually we, we're using digital these days, so to be honest, we don't need as much magnification, we can do that with the, with the computer. That type of thing we're looking at, this is actually that is that kite we've got a fracture in the ulnar and we can see it's linked into some gunshot. From the other angle, this is the 90 degree view, again, we get more view of where how many bits are available and we can see there's no displacement of those fragments.
So that's one which we can hear with rest. We sometimes do slightly different positioning. So this is, a falcon.
We're looking at doing, this is a stress shoulder view. So we're putting the wings upwards and cranially, trying to pull the shoulders out. This is particularly important.
We think we've got shoulder injuries and shoulder fracture quite, quite common, the pectoral girdle gets quite exposed. And here's that we can see how much further forward these are, and now we've got a clearer view of the scapulae. In this case we can see we have got fractures within the peal girdle.
We see the scapi now come out much more easily visible, by doing that. If I compare what they look like, this is a more normal shoulder view. See the scapulars down here, and this is a stressed shoulder view and we've pulled the scapular and we've got a much clearer view of the entire pectoral girdle with the coracoid and the clavicle.
Some of the things, X-ray things are not actually part of the bird, and one thing I will stress, if you do have a bird, potential lead poisoning is do and it casts, so it produces the indigestible parts of its food as a raptor, do X-ray it and make sure and see whether those bits of shot palette have come out. You can look very silly and I have done this when you go and try to remove and find the bird's already done it for itself. So we're gonna start by looking at the normal and normal views on how to interpret those.
And the big thing is how to view these. Really you want some peace and quiet, you want to go somewhere nice and, dark, you want to, . Be able to concentrate, take your time, especially when you're first doing these things.
If you've got some atlases of normal radiographic anatomy, you're just learning, it's not a bad idea to take those in with you and compare, what you're getting on those. So really time, just take your time. How you do your pattern of reading, again, individual, .
You're looking at essentially a big exercise in pattern recognition, so you know, you, it's how you, how you do that in your own brain is, is up to you. I always start with checking positioning, and I'll start with looking at the bones, and that's that's my, my starting point before I move on to the internal structures and soft tissue. So this is our normal view.
This is our vented dorsal view. We can start by looking positioning and what we're looking to see where the keel is above the spine in a nice straight line. We can see that's there too.
We also look at the, this is our wishbone, this is our fircula, and to see where that looks symmetrical, which is near enough does that. So again, a good point of fact we got this bird nice and straight. And that's a good, good starting point with that one.
So looking at bits and pieces, this is the heart. Once we've done bones, obviously, but here's the heart here, we can see that silhouette there. Further down, we've got the air sacs.
So if you like we have the black part of this hourglass figure here with the heart here and going down to the next bit there, and the, the black part is, is, is formed by the air sacs. And then the next shadow down the bottom part of the hourglass. This is the liver and stomach combined, liver and proventricular combined.
Can be hard telling apart. We're gonna talk about that later on. And down here we've got this what I generally call soft tissue squid, and this is a mixture of kidney, reproductive, gut, everything that really difficult, especially vegetables to tell these bits apart from there.
One thing we do is when we've got looking at the stomach liver shadow, we will draw lines upwards and they should fit within the pectoral girdle. If that shadow is outside there, that's gonna point to either the stomach or the liver is enlarged, sometimes both. Looking at a heart, this should be about, we measure for across the rib cage, across the heart.
That should be no more than 2/3 the width of the body. And large that again, we might be looking at cardioomegaly. Now importantly doing cardiogaly is that we, we talk blindly about birds.
We're talking about radiographic interpretation of potentially several 1000 species. There are some generalities, there are some, . Some size similarities, but you are gonna need to know some of your normals for each anatomy before you really interpret.
So that's where the atlas is come in, very useful indeed. Also, we look at ventrosal, we're looking at the lungs, and if you hopefully you can just see on here if it's striping. Don't forget with birds with their lungs, they're fixed.
The air goes through these bronchioles all go in the same direction. So on the ventro dorsal view, you actually see, see a long the air bronchioles, and you can see those stripes on there. And that's a good sign.
First, you have a nicely positioned radiograph. Secondly, not too much movement, blur and stuff. And thirdly, just about that detail, shows you the you know the lung structures OK.
So looking at a lateral view, it's lateral lateral. Again, we're gonna look and see other his shoulders straight, other hip straights a little bit of rotation here, so our hips aren't quite aligned, but it's close enough, it's probably OK for the internal body parts. I might worry slightly if I was looking at stomach and we'll do that stomach size later on.
But for here this is OK. In some ways, you're certainly looking at lame birds, you want those hips, to be, be staggered there because you wanna be able to see the actual joint itself. One thing that's important to raptors is these two joints here in the spine.
These are the only two movable joints along the spine, and we do get injuries on there too, so it's always worth paying attention if, if, you've got a bird which has got potential lameness or neuropathy in, in, in the, in the, in the legs. So looking again, here's the heart, this time in lateral view, we can see that here. From there we get the great vessels and we can see those extending upwards, we can see those along there.
Sometimes we see great vessels going along here as well, but in this case we've got a little bit of fat so we can, we can only see them in in the cranial part of the body. Here we have the lungs again, it's again lateral view, we'll talk about those in a second. This is the proventriculus, we can see that coming through here.
So it's the oesophagus here. The crop by the way is up here. So disussphorus here and then we went to the proventricular there.
And here again is our soft tissue squid. In between that we have the gizzard just here. Kidneys are just below the pelvic girdle and we can see them poking out into the just about into the air sac there.
And here we have a gonad. Now in a female, this can be really quite large and reproductive activity and joined a whole soft tissue squidge at the back here. And here we have where the spleen should be just about maybe just see the spleen there.
Now if you've got splenomegaly, you'll see that very clearly. In a normal bird, sometimes you don't see it at all, but that's where it sits just between, on the isthmus between the proventricult and the ventriculus. And here we can see the the ribs and the keel and underneath those between the stomach and the heart, we have the liver.
And if we don't very easily see the liver on the lateral view, where you're more likely to see it again, we'll see later on is by positioning the stomach as to inference liver may be enlarged. So we look in detail at the lungs. This time we're looking at the bronchioles, end on.
So we're seeing, if you like, almost like a fingerprint here with with these little round circles all through again, just like looking at the view, it's a it's a good, good measure of detail, good for respiratory knowing to see those. So we need to know what's normal. We need to almost by species or species group, that's important.
Always we're interpreting, when you say what's being radiographed and why. So the history is really important, and so are your findings from clinical examination, and everything else that it's really hard to read and interpret a radiograph without knowing those findings because otherwise it can be really quite badly misleading. Again, I used to assess those thoughts and go through their rotation, poor positioning, over and develop development, don't forget to put your left right markers on, that's really important too.
If you're submitting . Digital X-rays to people, please, don't over edit them before you do it. It's quite nice to have the actual original and refer back to that because you can edit all kinds of artefacts in as well as taking some out and try not to use JPEGs.
JPEGs are great for transference, because they're they're small and compact and are easily moved, which is what they're for, but they are really short on detail. So if you want somebody to really read it properly, send them a full dicom image or whatever. So we're gonna start by going through some of the bits and pieces of the abnormalities we'll see, and we're gonna start with the sort of bones and joints because that's how I start and how I, I tend to look through.
So again, here's here's our normal view. Let's go through a skeleton obviously we've got the our our our petrol girdle here with our fircula with our coracoids and scapula underneath here. We've got a rib cage, and we fall in, we've got the, humerus, the ulna on the radius and got further below that.
Here we have the femur, we have the tibiottarsus below it and be here for metatarsals, and so on. The bones are pneumatized, different degrees, different species, so most of them will have pneumatized humeri. See the air filling in here.
The femur is pneumatized in it does does vary between species, whether it's pneumatized or not. So again, can be normal can we not, we'll see how that varies in reproductive cycle as well. So we're looking back to think we're looking at some things like fractures and here we can see a comminuted fracture of the of the ulna here.
And here again we can see associated with some shot. Sadly we still do see quite a few shot raptors, which is really sad. But again, these are all part of decision making about what to do, about how to repair and stuff and and vitally important.
Other fractures may be more displaced. He's a humeral fracture. We can see that they're quite displaced here.
We know we're gonna have to, if we go back a bit, these sort of fractures, we, we can, we can leave to heal by, by, by, by just grinding where we just callusing, we won't even bandage these because otherwise we get the radius tied into the repair. Here, we can't do that. We we're certainly gonna have an open fracturing here that's coming up through here.
It's probably almost certainly torn through the skin. That's gonna make a very different prognosis to, to this bird. We'll look at, other lesions is osteomyelitis.
So here we got a lateral view of foot. And when you're doing feet, don't forget to tape out the toes and keep away from each other. But we can see this, first, phalanx here has, acoustic quite fuzzy it is.
We've got osteomyelitis about that area there. We can see associated soft tissue swelling around here as well. This bone density is important as well.
This is a buzzard which, actually I knocked over many years ago, on a, on a back road and, picked up a young bird, and it's very pale, and we can see these bones are very curved, and I took it back to surgeon and X-rayed it, and we can see the curvature on the bones. You'll see head to toe, OK, it's a very old platex it's been photographed, but we can see these, the density is not, not correct. There's a, there's a severe lack of density on those.
Other, me bone diseases, they're not all, they're mainly gonna be nutritional secondary hyperparathyroidism, but this is they don't always show to quite the extent of that that buzzard. This is a battler eagle, it's imported, and being fed just meat as a chick. And what we can do is we can actually see, there's a good bit of anatomy this.
Because we have on the leading edge wing we have a tensor pataialis tendon and it has a pars longus which attaches here and a pars breviss here. And what it's doing is when it's, pulling its wing up in normal sitting position because the bones are soft, they're being pulled out of shape. And this is a bird that once he matured, couldn't fly very well at all.
We see increased bone density. We'll talk about more later on there, but this is certainly what we'll see in, breeding condition. So if we see this picture, we got, extensive calcium deposition through all the wing bones through the all the leg bones, even pneumatized bones are full of calcium.
This is a pretty good pointer, that this is a female bird. This is the female bird in a high oestrogen phase because it's, moving calcium out more and laying calcium down ready for egg laying. So that those these are associated with that.
Another area of importing raptors, we'll see most winters, we see a few cases of wingtip edoema. We tend to radiograph these, . This is the actual lesion.
We see this edoema of the wing tips there and X-ray you can see very clearly you got this edoema between the feathers. What happens is if it doesn't go right, is that you lose the wingtip with necrosis. It tends to necrose through this level here about very about a second phalanx.
So we, we radiograph those. This gives some prognosis. So here's a couple of cases these are fairly normal.
We can see that a phalanx there. We can maybe see just the beginning of a change there, but soon we get to this, we can see that's beginning to grow through here, and this is the case that did lose its wingtip. So it's well worth doing that, and just looking at that second phalanx and seeing whether we can see the necrosis, and that's gonna give us a good good or bad prognosis for this particular case.
Other thing do certainly in small birds, we often reverse them, so change of black, white, levels so the bones become black. And this can be quite useful looking at hip joints, particularly in small birds, we can show slightly better, on that. So these there are radiographs can be quite good.
If you can do that, it, it's, it's quite useful. So looking at the joints themselves rather than the bones, again, some of these can be quite subtle. So particularly if I'm doing carpi, I'll be very keen on radiographing both sides, and these are cra a chordal views, and this is more normal here and we can just about see we've got some fuzziness, a bit more, roughening of the joint surface on, on this part here.
It a bird with a with a drop wing. So, you know, if it is a subtle lesion, don't be frightened to to do the other side just like we would with a dog or a cat. Some of these things are obvious, we can see in this interarsal joint, we've got sense of new bone formation, very rough surfaces, and we show again we can contrast that with how the intertarsal joint should look.
Again, this is a female bird. Look at these, these, these calcified bones. Hips are probably the hardest ones to view, and I must admit these days we probably tend to put these through CT rather than, rather than X-ray, it's so hard to read.
Occasionally get a very obvious change and, and in this sculpture we can see new bone formation and extent of hip arthritis on both sides. But, these can be hard to image, especially if you've got, a gizzard with stones which often overlies this sort of area. We can see again, joint changes.
We got infection here. It's a septic, arthritis of the shoulder joint. We can see roughening around here.
We can see, loss of bone, loss of joint detail. And again, this is a flying bird, this is a very, very poor prognosis indeed, extensive soft tissue change as well. With some I see new bone bone formation around the joints, the penguin with, chronic, arthritis, so it's around into touch and we've got to get calcification of the tendons, as they go over, over the, over the joint, and some soft tissue swelling on its foot would be associated with bumble foot.
We will normally radiograph bumblefoot, in raptors because we want to see whether you got underlying osteomyelitis or whether we got nice clean joints. In this case, this looks OK. This has got better prognosis.
So we're looking at smooth sort of surfaces. This is not the best positioned X-ray, as we've said before, we should be looking, we should be trying to pull the toes out separately, which I haven't done here. And here again we see more extensively soft tissue lesion here and .
We have probably a bit of roughing the joint surface in that bit there too, which is probably our area we're most concerned about. Again, this is one of the dangers we have, we sort of do try to reduce the number of plates we use in development and sometimes just be careful about trying to get too much on one plate. And so if you need to do two plates, do 2 plate.
These are two, carpa again showing the viability of we need to show a normal, just a more normal carpus. If we're looking at here, we a dislocated carpus. We can see they're not, it's not lying right planes, and that can be quite hard to really pick up with the overlay and stuff which bits are, which bits, what level is it dislocated.
Again we mentioned about reproductive and again really important with this one. Now the other feature you may have noticed, hopefully you noticed, with with this particular bird is we've got, there's the heart. There's our gizzard.
Now a gizzard is actually underneath the hips. It's been displaced backwards. Can we talk about this a bit more later.
But we've got a soft tissue mass between the heart and then this is back to this thing where the liver can be inferred to be large if it's displacing an organ, distal to it. And in this case we've probably got, we got hepatomigaly, we've got this high calcium status, showing reproductive status, and this means it's like hepatic lipidosis becomes a very, very, very likely diagnosis in this case. So Let's use it again, reproductive status again, we can look at a chicken, and if they're fully in lay, we can sometimes actually see the follicles.
Otherwise, we would often just see a big mass of of soft tissue, in the abdomen. Here we've got the, we can see the the individual follicles. In this case we can be quite useful.
This is, . A cockatiel. You see you've got a very swollen abdomen.
We can see it's got some fluid there. We probably palpate fluid, and we see it moving. So it's very yellow, which makes us think about yolk and stuff.
We take some X-rays and see what's going on. And this is our typical appearance of acidic, fluid, which is a very big whiteout of that of, we do have a peritoneal cavity, but this is a big white out abdominal peritoneal area. And, this is one of those cases where actually radio radiography doesn't always show us too much.
So we actually go to old sonography, which shows more of the detail there too. Sometimes we we see eggs, in this case here we know it's a, it was egg bound bird. We know it should be able to pass OK because it's come through the pelvis.
So it's distal to the narrowest part of the pelvic cavity. It's waiting to be laid, and now we've got to just try and get the sphincter to open and be able to get that egg to pass out. It's well worth radiographing, these cases even though that's usually clearly palpable, because, you know, these are great, these are nice normal, eggs.
They, they should be able to pass OK can distal to the pelvis, so that should really pass quite easily, with. But when something like this, we can see we've got an abnormal like, we can see we've got breaking here. And this is we have to be very careful how to get that out.
Again, still within the pelvic cavity. This sometimes will actually, and not the calcification of the bones. So those cases where it's actually within the pelvic cavity right now, it hasn't come through.
This is one where's probably gonna be a lot of pressure on the kidneys, for an extended period of time, we'd worry about that just because space occupying effect in that very narrow pelvis. So you're probably gonna want to get a move on and do something more, more, more quickly. It's gonna be quite hard to remove.
You don't have to break this down, or you're gonna need to even think about going in and doing surgery to remove it, because it's not necessarily going to pass normally as a whole entity because it's got, it is broken, it's got some broken bits there. So One of the reasons why birds are really called radiograph, we probably do even more women than dogs and cats, is because we've got contrast inside them. And you've been seeing these air sacks, I've kind of brushed over them a bit.
But actually they're the reason why birds are so called radiograph, because they're full of negative contrast. And what this is doing is showing up the, internal body organs much more clearly. So, Whereas in dogs and cats, and abdominal radiographs are nightmares to read, they are much easier in birds because we've got this contrast.
Sometimes we'll lose that negative contrast, and this is another ascetic bird, this cockatoo, but it's got a complete whiteout there, and that's an ascitic bird. It's actually a bird with heart failure, and that Ay is gone. That's where ultrasound comes in much more useful.
So some people actually lose the air sacks. And so this is a case here we can see the air sack on this side. But we can't see it here.
We've got something actually within it. And this will be a granuloma, almost always, and usually a fungal one at that too. And so see this complete loss here, maybe odd pockets of air appearing with granulomas, and sometimes we'll see the walls of them as they appear on the lateral view.
Again, always used to do those two views as the the lateral and the ventro dorsal and then you can see which sides affected, you can see how extensive that is to and where the air entrapment is too. We'll also get loss of negative contrast with we got very fat bird. So that may be due to direct body fat, and we can see here maybe impinging if you like from the sides and overlay here.
But also from the liver is very large, so you've got very narrowed air sacs because of the increased width of the of the liver stomach shadow. And sometimes we have too much, and this is a trauma case, and we can see the air sacs have been broken and they've ruptured between the heart and the liver here. It's a rare case you actually can see the liver and actually see generally see the whole of the heart as well.
So that can be important. And the other reason you may sometimes get very large air sacs is where you've got blockage. And if you see this sort of situation, you've got overinflation, these caudal air sacs.
This is the abdominal air sac that's been really overinflated. This is the the lateral view of this bird. And this is almost always gonna be due to aspergillosis, where you've got aspergilloma somewhere up around here or maybe even slightly higher up, which is blocking the air flow.
And so these cordal air sacs are overinflated and that's really useful. So with aspergillosis, with granuloma formation, we expect to see a loss of air sac. Actually just sometimes we'll see increased air sac.
So watch out for that too. But what we can see when we have got normal amounts of air and stuff is we get really good over outlining of the internal organs. So we can start with the spleen, and we sort of saw earlier on there.
This is what a splenomegaly does look like. We can see that there's the proventriculars. There's a ventricular.
Here's the isthmus and here's our spleen sat over the top there. That's a splend got some kind of systemic inflammation. We mentioned about kidneys and again, here they are, we can see them outlined along here underneath the pelvis.
And sometimes they're very small or you should be, but occasionally if you've got to renal disease, you may see them not only larger and so more protrusive here, but also you'll get, some of the increased density of a kidney and that can be pointed to problems. Here again, we'll also sometimes use the positive contrast part. So we've got a nice gizzard with some stones in it, some grit in it.
We can actually use that to see where things are. And here the gizzards displaced cranially. It's displaced ventrally, which means we've got something up here that's pushing it that way.
That can be reproductive organ, but in this case, and especially in budget regards, it can be a renal adenocarcinoma, which is not, not unusual. We can just about see the kidneys on a vented dorsal view, often we can't, but if we start seeing this prominently, again, we can just see outline here, again, I start to start start to question, whether we've got some renomegaly as well. We can see the heart, we we've seen that before.
We've, we know the normal sizes, and we've got a nice silhouette here. And this is quite useful. We will see cardiamygala.
We'll also see increased density of a great vessels, where we have atherosclerosis, and that's quite worth looking out for. And we also see that hourglass figure being lost. So here we have, a cockatoo with with cardiomegaly, and we can see that the hourglass are gone is like kind of going straight down the sides here towards the liver and stomach shadow.
And again, in this case as well, the smaller bird. So again we've got that loss of the hourglass and that's due to the increased size of the of the heart and the lateral view again just get almost forms a continuous soft tissue blob, in that region. Liver size is also important again, we we look at a shadow here, stomach and liver shadow.
We can see which be within the pectoral girdles we know. But here we have cases where we have got absolute loss of the air sacs. So we lost our negative contrast.
We've got this huge wide. Bottom part of the hourglass here, and here. Now in these cases, this could be stomach, this could be, liver.
In this case, we can see where the gizzard is and it's, it is displaced record. It's behind the hips. So that's going to be potential for looking at probably being more like to be liver because it's actually being physically pushed backwards.
In this case, we've got no visible gizzard. That's quite hard to tell which particular organ we have got enlarged. And that's when you start doing additional tests.
And this is where it helps. We've got some positive contrast. This is smaller bird, where we've got the gizzard pushed behind cordal to the hips, and again, we see how far back is on on the ventro dorsal view.
Get grit is really useful for small birds. Big birds don't tend to have it, but ones do. And again, it's a big point of fact we've actually got .
Hepatomegaly rather than large stomach and that's what's pushing the the the ventricular backwards. But if we haven't got that grip there, we actually do need to introduce our own positive contrast, so we put some barium in just to outline the stomach and then show which part's stomach and which part is . Is liver.
We're gonna a brief digression while we're there. We mentioned about how useful grit is. Don't forget we do see occasional foreign bodies.
So this is a bird of prey. This is fed deliberately. It's called wrangle.
Sometimes the stones there can be part of a sign of, sign of disease and can cause problems. Certainly if you've got a bird expecting to fly with this much stone inside, it's probably a problem. We do see occasional bone umactions, as in this case here, and this is the esophageal perforation as well, which is why we had respiratory disease.
And we had this, which is an air sac tube, it is not a foreign body, but we had a respiratory due to a protrusion through here. In this case, this is a Bengalese eagle owl, which had poor stomach motility, probably because of the spinal arthritic lesions. So Louis look at these two joints here.
And this is just a big stomach full of leaves and sticks and debris. Not quite sure why it ate it, but it did. I'm pretty sure that the sum of motility was reduced because of spinal lesions.
So again, never just look at what you're looking at, look at everything else well and see where's more complete stories and reasons why things are happening around that. This is a gossip with sand impaction again, this is quite common.and shows really clearly.
But again, this is what what positive console will do. It really outlines that stomach, that stomach shadow. We see how large that is too.
This means this, this hourglass figure, the rest of the shadow is liver. So we can see that's a fairly normal liver. We can see there's the stomach, where's the heart.
So this here is the liver on the lateral view. So it's really useful to have that. Just a real weird case this we see a casual case of IDS and a very occasionally you'll see the the small intestin blown up with gas.
And again it's impinging on the, on the breathing system. We will, each case I've seen is actually presented as dyspnea. It's very, very unusual, but we'll see them occasionally.
Sticking with foreign bodies, mind you, most of these are soft and so this is again where we want to put our, our conscious material in there too. We won't see these on straightforward X-rays. This was a foam block inside a minor bed and we can see how the how it's being outlined by the contrast.
The other thing we worry about with stomachs is perventricular dilatation disease. This is a viral problem, where you lose motility to the stomach, the stomach becomes very, very thin walled on postmortem. It is what it looks like we actually see the seeds through the, through the stomach wall, and generally these birds can get emaciated due to the, lack of ability to absorb, and to digest their food.
Now, One thing you'll hear a lot, which is a confusing part, but . The definition of perventricular dilatation disease is that you've got dilated perventriculis, but we'll also see that this thing called perventricular dilatation syndrome. So if you see a very large stomach, a very dilated proventricu on radiographs, that doesn't mean it's PDD.
It means it's, prevent dilatation syndrome. There are differentials apart from the viral problem. So, you know, we've, we've got to do some testing with direct how we're gonna do.
So don't diagnose PDD on the on the radiograph, but use that to direct your investigation. So we suspect premontic disease, if they're very thin, we we we've got they have an a normal appetite, increased appetite sometimes when terminal stage may be anorexic. Some is just not very well, some very occasionally regurgitate, but certainly if you see undigested seeds in the faeces, that's a really good point in that we've got proventricular disease because they're not being ground up in the stomach.
So we radiograph. Now, do those ventilateral as before, again, you'll see that increased. Liver stomach shadow.
Here we may get a better idea. We've got a soft tissue density here. This is mainly stomach, which can be quite hard to interpret.
So very occasionally you'll, you'll be able to do on plain radio radiographs. You got some stuff in the ventricular, you might be able to see it. There is a formula to talk about at the moment, and that's looking relationship of keelsy to proventricular, and this was published by Denizen, and you've used the keel width and you do a complicated formula.
And if it's more than 0.52 that means dilation. You do have to be very careful on your rotation and positioning for this.
If it's more than 10% rotation, it doesn't work very well. So the easiest way is we put contrast radiographs and then we put barium into here. And here we go, we can see what happens if we outline the stomach.
The stomach is absolutely enormous, and here we have a clearly dilated stomach. Where we do that is we can put it in the crop if you want to, just standard crop tubing. The trouble with that is you may have to repeated radiographs, especially for private diltation diseases because the motility is often slow, so it can take a few hours.
So you often knock your bid out again and again, . And there's an increased risk of regurgitation inhalation of the, of a bearing at that point, which is a bit of a worry. So I tend to put it directly into the proventriculus using this tubing technique.
But in this as you can see, we position on its back, it's OK, we keep it straight. And we basically place, this is a dog urinary catheter and use those stress, which we place into the crop. And I'm feeling, what's in the crop, I'm feeling it in my fingers.
From a side here, what I'm then doing, my finger and thumb are actually positioned on the ventral process of the spine. And what I'm doing is I'm feeding the tube through my finger and thumb. So along the midline basically, and I'm gently probing the distal oesophagus.
I'm not gonna push, but if I do that, we, we'll see the consequences in a minute, you're actually gonna rupture the distal oesophagus, you're gonna get stuff place you don't want it to go to. So I'm actually feeling it and when it enters this of course, I just feel it just gently pop through and it goes down in towards the stomach. And then I can place my, my contrast, I can see this type of thing again you see outlining a food in the stomach, see how large is it too.
It's amazing how fast it I very typically put the contrast in and then take the tube out, position for a radiograph, take it straight away. So usually less than 2 minutes after I put the contrast, with even reduced motility, we can see we got dilated. Continent for sporting testing how dilated it is.
And again, 2 minutes later, again look at how fast it's flowing through even in a case where you've got dilation of the stomach, and it's a problem. You always get a little bit come back up or as, as you're, withdrawing the tubes, you get some filling in the crop. So that's normal.
And sometimes it shows you stomach is actually normal size. We can see that's nice, normal stomach. And here's the liver shadow here and we can get an idea of and probably this, this enlargement is due to hepatomegaly.
So again, really useful just where we need to be. So again, just makes it more confusing. Sometimes the pros in normal sizes in here, but you've got dilation of the small intestine as in here, this is a very wide small intestine, very small bird.
So just be a little aware of that too. Sometimes you'll see this gas filling and certainly we see this cloacal A that might be another pointed towards PDD. So it can get quite confusing.
It can go wrong, and this is one where I pushed the tube in, I didn't realise I'd ruptured through the oesophagus pusher contrast in there, took my radiograph and as it came out, I just thought to my horror that I'd filled the lungs with barium. Now the bird actually controlled quite well for about 6 weeks, then sadly died after that. But we did have a rip roaring pneumonia from that, and we want to try and avoid that.
So how can you do that? Well, actually, what I tend to do, and why I skipped at this stage, I've got no idea. But what I normally do is I'll place the tube where I think it is.
I will then place in there about 5 mLs per 400 grammes of saline. And wash that through, and then withdraw some. Now that gives me two things.
First of all, if I've gone into the air sacks, I'm gonna get very little, if any, saline back because it would just go in the air sacks. I also probably get some blood back, which I wouldn't normally expect to find if I'm washing out the gut. And if I'm washing the stomach, I'll get green stomach contents and bits of seed and stuff.
That gives me a lot of reassurance in the right place. Now the other thing too, also gives me a sample, because if I'm investigating cause of dilation, I now have a stomach wash. I can send that episode.
I can send that for culture and that's gonna pick up some more unusual differentials. So it's a good thing to do. So when you're placing a proventricular tube, always, always check and do a, do a, do a saline wash before you place the barium and that way a lot of disasters will .
Will be avoided. We can use positive in other places too, and certainly we haven't got CT available. If you're investigating sinus problems, they're really common in, in, in, in parrots, then putting some contrast into sinuses.
Typically, you can put a place in my nasal flesh, but easiest, more accurately to put it in straight into the sinus. So just draw a line between the nostril. The latch of the medial campus of the eye and probably about a third of the way along, just put a needle through the side of the sinus, and you can introduce a contrast from there.
These are cases and grey parrots of colarezia, where the drainage hasn't formed properly. And you can see this is not draining down into the, into the mouth and into the pharynx as you expect, but it's actually trapped within the, within the sinus area. This is how it should drain.
I was a CT. I know I'm cheating. And it should drain nice and frilly through this koa.
So hopefully, that's given everybody some ideas of what we can do with radiographs, what it's going to what it's gonna show, and this is what I'm hoping you've got from this very, very quick fly through, avian radiography. So hopefully this give you some idea on the importance of radiography, just how many cases applies to and how you're gonna use this when we're dealing with birds. Hopefully, some idea about how to take a radiograph and also how to use contrast and when.
So particularly when you deal with upper respiratory problems when we're dealing with potential proventricular problems, or even trying to distinguish between the stomach size and the liver size, we want to use positive contrast. Hopefully we're gonna be so what a normal body radiograph looks like, and again, how are you gonna use atlases and and compare that, how to read a radiograph of a bird because the first time you look at and think, oh my goodness me, what's this? We all do it, don't worry.
And therefore what not normal looks like. And once you go ahead to normal, not normal becomes a lot more clear to to see and to do and therefore that's gonna give you a lot of range of differential diagnoses, a lot of clinical information for each case. Thank you.