Technique for basic abdominal ultrasound examination

Technique for basic abdominal ultrasound examination

of the dog & cat
Panagiotis Mantis DVM, DipECVDI, FHEA, MRCVS

Animal positioning
Unless otherwise stated:
Position dog in right lateral recumbency with the head towards the ultrasound machine
and the legs towards the examiner.
Clip from the xiphoid to the pelvis inlet and halfway up both sides of the animal.
Always have your thumb or your index of the transducer marker.
Orient the transducer on the ultrasound machine screen with the marker on the left of the
screen.
Set up your machine properly.
Liver & Gallbladder
Position the transducer parallel to the tabletop just caudal to the xiphoid with the marker
pointing to the head of the animal.
Orient the transducer so that it points towards the level of the shoulder joints.
Rock the transducer to cranially or caudally to have the liver in the middle of the screen.
Fan the transducer all the way to the left and all the way to the right of the animal till you
cannot see liver on each side.
Rotate the transducer 90 degrees counterclockwise and fan the transducer all the way
cranially and all the way caudally till you cannot see liver on each side.
The gallbladder will be visible on the right side of the animal.
During the movement evaluate the liver and gallbladder.
If the dog is very narrow-chested with no space to place the transducer caudal to the
xiphoid adequately to examine the liver, clip the hair on both sides and examine the liver
by placing and moving the transducer between the rib from both sides.
Spleen
From the liver, and with the marker on the transducer pointing to the head of the animal,
slide the transducer to the left abdominal wall of the animal along the last rib, feeling the
last rib cranial to the transducer until you identify the spleen on the screen.
When you see the spleen you are either near the cranial margin or just caudal to it. If the
later then slide the transducer cranially at the last intercostal space to identify the cranial
margin of the spleen.
Fan the transducer dorsally to see the spleen in the rib cage and then fan ventrally
before you return to the starting position.
Slide the transducer mildly caudoventrally and repeat the fanning dorsally and ventrally.
Move your transducer caudoventrally and repeat fanning.
Repeat this till the caudal margin of the spleen.
Then rotate the transducer 90 degrees clockwise and slide cranially following the spleen.
When you arrive at the last rib follow the rib ventrally.
During the movement you evaluate the spleen.
P. Mantis

Technique for basic abdominal ultrasound examination

Stomach
The stomach is caudal and left to the liver.
Once identified fan the transducer dorsally to the fundus and ventrally to the pyloric
antrum.
Then return to the starting position and start rotating the transducer clockwise till you
have a long axis view of the stomach along the screen.
Rock your probe dorsally towards the fundus and then ventrally towards the pylorus.
If needed repeat examination from the right side.
Intestine, peritoneum and lymph nodes
It is impossible to examine the intestine from duodenum to anus.
Slide the transducer along the left flank and the right flank (in larger or fatter animals)
following a castle pattern till the pelvis inlet.
Examine any visible intestine and look fro visible large lymph nodes and any peritoneal
abnormalities.
Pancreas
Right Limb
Small and medium sized dogs and cats
The transducer is oriented in a sagittal scan plane, parallel to the tabletop between the
tabletop and the animal roughly halfway up the right flank.
The right kidney is located and then the transducer is withdrawn away from the animal.
The descending duodenum falls into view.
The right pancreatic limb can be seen between the duodenum and the right caudal
aspect of the liver. Mild fanning of the probe is required. The pancreaticoduodenal vein
can be identified in the right limb of the pancreas.
Large Dogs and any size dog
Dog is positioned in left lateral recumbency
The transducer is positioned dorsally at the level of the last intercostal space and is
angled cranially, dorsally and medially.
The caudal pole of the right kidney is located and placed in the centre of the view.
The transducer is then moved ventrally keeping the transducer orientation and the first
intestine to be imaged, at the top of the screen, is the duodenum.
The right limb is visible between the duodenum and portal vein on the ventral aspect of
the caudate lobe of the liver.
Minor adjustment in the angle of the probe may be required for optimal visualization of
the right limb of the pancreas.
Body of the Pancreas
Animal in right lateral recumbency.
The duodenum is located as for the right limb.
It is followed cranially till the flexure and then the probe is angled away from the tabletop
till the pylorus and portal vein are visible.
The pancreatic body is usually seen between the stomach and the portal vein in sagittal
images.
P. Mantis

Technique for basic abdominal ultrasound examination

Left Limb
Animal in right lateral recumbency.
The transducer is positioned caudal to the last rib to acquire a dorsal plane image of the
spleen.
Slide the transducer dorsally.
The left lobe of the pancreas is then usually seen in the region bordered by the spleen,
left kidney, stomach and transverse colon.
A large splenic vein is often seen passing around the cranial edge of the left pancreatic
lobe and the pancreas is between the splenic vein and the portal vein.
Left kidney
Left kidney is located dorsally behind the last rib or at the last intercostal space.
If the spleen is normal, find the caudal margin of the spleen and from there slide your
transducer dorsally till you see the left kidney.
Rotate your transducer for a dorsal plane of the kidney with the longest length.
Fan your transducer cranially and caudally to examine the whole kidney.
Rotate your transducer 90 degrees clockwise to achieve a transverse image of the
kidney.
Fan your transducer cranially and caudally to re-examine the whole kidney.
Left adrenal
Locate left kidney.
Maintain marker of the transducer pointing to the head of the animal and the transducer
body parallel to the spine.
Identify aorta at this level.
Identify renal artery at this level as it originates from the aorta.
Look cranially (left of the screen) at the level of the corner of the aorta to the cauda vena
cava while pressing a little stronger and fanning the transducer ventrally.
Identify the left adrenal that looks like a monkey nut.
Left ovary
Find the left kidney and slide caudally.
Fanning your probe dorsally and ventrally look for the ovary up to 2 cm caudal to the
caudal margin of the kidney.
In anoestrus may be very difficult to identify.
Aortic bifurcation
Follow aorta caudally till the bifurcation.
Medial iliac lymph nodes are located at the level of the aortic bifurcation.
Urinary bladder
Transducer, with marker pointing to the head of the animal, is positioned at the level of
the urinary bladder.

P. Mantis

Technique for basic abdominal ultrasound examination

Fan the transducer all the way to the left and all the way to the right of the animal (or
dorsally and ventrally if you are on the right side and not in the ventral midline) till you
cannot see urinary bladder on each side.
Rotate the transducer 90 degrees counterclockwise and fan the transducer all the way
cranially and all the way caudally till you cannot see urinary bladder on each side.
Orient transducer 90 degrees to the tabletop and place on the area of the urinary bladder
to identify and examine the dependent aspect of the urinary bladder.
Prostate
Create longitudinal image of urinary bladder and slide and/ or fan transducer caudally.
or
Create transverse image of the urinary bladder in the middle of the screen. Fan/ slide
transducer caudally towards the left hip joint keeping the urinary bladder in the middle of
the screen. the urinary bladder will disappear from the screen and the prostate will
appear.
The prostate is identified caudal to the urinary bladder. If intrapelvic it may not be seen
and an assistant can push it cranially through the rectum.
Uterus
Place transducer midline ventrally, keeping it parallel to the tabletop with the marker
towards the left side of the animal (pointing upwards).
Identify urinary bladder and descending colon dorsal to the bladder (urinary bladder at
the top of the screen and colon at the bottom of the screen).
The uterus is seen between the bladder and colon, as a hypoechoic rounded structure in
anoestrus.
Once identified the uterus is examined in sagittal and transverse orientations.
The uterine stump is identified the same way.

Right Kidney
The right kidney can be located in small dogs and cats like for the right limb of the
pancreas from under the animal.
It is easier to place the dog in left lateral recumbency with the head towards the
ultrasound machine and the legs away from the examiner. The rigth kideny is dorsally at
the level of the last two intercostal spaces.
Once identified, rotate your transducer for a dorsal plane of the kidney with the longest
length.
Fan your transducer cranially and caudally to examine the whole kidney.
Rotate your transducer 90 degrees clockwise to achieve a transverse image of the
kidney.
Fan your transducer cranially and caudally to re-examine the whole kidney.
Right adrenal
Small and medium dogs and cats
Identify right kidney from under the animal as for the right limb of the pancreas.
Keep cranial pole of the right kidney in the middle of the screen.
P. Mantis

Technique for basic abdominal ultrasound examination

Fan transducer upwards (medially) till you identify the cauda vena cava maintaining the
transducer orientation.
Fan mildly ventrally (laterally) trying to see the arrow-shaped right adrenal.
Large dogs and any size dog
Animal in left lateral recumbency (as for right limb of the pancreas).
Identify right kidney keeping the transducer in dorsal orientation.
Keep cranial pole of the right kidney in the middle of the screen.
Fan/ slide your transducer to identify the cauda vena cava (cvc).
When cvc is identified and seen across the screen, fan your probe mildly dorsally looking
carefully.
The right adrenal is seen having more monkey nut shape as soon as the cvc
disappears medial to the cranial pole of the right kidney.
Right ovary
Find the right kidney and slide caudally.
Fanning your probe dorsally and ventrally look for the ovary up to 2 cm caudal to the
caudal margin of the kidney.
In anoestrus may be very difficult to identify.

P. Mantis