which would not be the strategy to resuscitate a case of dilated cardiomyopathy, and emergent pericardiocentesis would be the treatment for pericardial effusion/tamponade, with inotropes for dilated cardiomyopathy.
Figure 7.9. Composite showing comparison of abdominal radiographic serosal detail to AFS and value of serial examinations. (A) Abdominal radiographs of a dog with automobile trauma with markedly reduced serosal detail. The dog has a minimally displaced left acetabular fracture with an unimaged urinary bladder. (B) The initial AFAST determines that the dog has an AFS of 1 positive only at the DH View (gray circle). On the four‐hour postadmission AFAST the AFS remains the same. (C) The AFAST on admission is again a 1 which in fact was found with the abdominal radiographs in (A). On serial exam the dog worsened with an AFS of 3. The fluid pocket was large enough to be accessed via abdominocentesis and its fluid analysis documented the large‐volume bleeder hemoabdomen. The dog seemed stable based on physical exam, vital signs, and blood pressure with a normal PCV when in fact the dog was exsanguinating. Over time, the AFS was tracked and the dog received a blood transfusion due to developing anemia. Serial exams may be continued every four hours to every 12–24 hours on patient rounds, depending on clinical course. The serial exam thereafter documenting improvement to an AFS of 1 is invaluable patient information. (D) Images of the initial and four‐hour postadmission serial AFAST showing absence of a urinary bladder and then its expected rounded contour post fluid resuscitation. The urinary bladder was missed initially likely because it was small and caudally located but in critical patients, the serial AFAST may be better used to decide on urinary bladder integrity post resuscitation.
Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX. Illustration by Hannah M. Cole, Adkins, TX.
Figure 7.10. Normal and edematous gallbladder wall and sonographic striation. The gallbladder is represented by the black oval and the diaphragm is the white curved line mimicking the DH view. In (A) the gallbladder wall is normal and represented as a hyperechoic (white) thin line. In (B) and (C) the gallbladder has sonographic striation that alternates hyperechoic‐anechoic‐hyperechoic (white‐black‐white) and hyperechoic‐hypoechoic‐hyperechoic (white‐gray‐white). The inner and outer walls are shown as white lines with the intramural edema (black or gray) in between. The gallbladder wall does not have to be of abnormal thickness as dogs with an anaphylactic gallbladder can have sonographic striation with a wall thickness of <3 mm (Lisciandro 2016b) as shown in Figure 7.11B.
Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.
Figure 7.11. Gallbladder wall edema in dogs with anaphylaxis. Three different images with two different degrees of gallbladder wall edema in two different dogs at the AFAST DH view. Images in the top row are shown in the bottom row with correlating line drawing overlays. A normal gallbladder wall is for all intents and purposes a thin hyperechoic line as shown in (A) and (D). The gallbladder wall “halo effect” is in fact intramural edema that images as a hyperechoic inner wall, a hypoechoic or anechoic sonographic layer of intramural edema, followed by an outer hyperechoic wall. The sonographic striation, white‐black‐white or white‐gray‐white, is also referred to as the “halo sign” or “double rim effect” (Quantz et al. 2009). (B) and (E) is the same image unlabeled and labeled; note the small triangulations of free fluid (outlined with triangles), which would be scored as an AFS of ½. In (C) and (F) is another case with canine anaphylaxis with the same image unlabeled and labeled. The curved white line represents the diaphragm. Degrees of gallbladder wall edema in the author's experience do not correlate with severity of anaphylaxis. Gallbladder wall edema, although a marker for canine anaphylaxis, is not pathognomonic and PCE and right‐sided heart failure are major rule‐outs in the acutely collapsed or weak‐hypotensive dog (see Table 7.5 and Figure 18.22).
Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.
Table 7.5. Rule‐outs for the finding of gallbladder wall edema in dogs and cats.
Source: Reproduced with permission of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.
| Condition | Expected characterization of the caudal vena cava (CVC) | Speculated pathophysiology |
|---|---|---|
| Canine anaphylaxisa | Flat, hypovolemic CVC, (see Table 7.6) | Massive histamine release resulting in acute marked hepatic venous congestion |
| Pericardial effusionq | FAT, distended, hypervolemic CVC, referred to as vena cava plethora in people (see Table 7.6) (Himelman et al. 1988) | Marked hepatic venous congestion from obstruction of blood flow to the right atrium |
| Right‐sided congestive heart failure (dilated cardiomyopathy, pulmonary hypertension, tricuspid disease)a | FAT, distended, hypervolemic CVC, referred to as vena cava plethora in people (see Table 7.6) (Himelman et al. 1988) | Marked hepatic venous congestion from backflow of blood from the right atrium |
| Cholecystitis | Variable | Direct inflammation |
| Pancreatitis | Variable | Direct inflammation |
| Hypoproteinemia (third spacing) | Variable | Vascular leak |
| Immune‐mediated hemolytic anemia | Variable (author experience, unpublished) | Likely immune‐mediated and volume overload, does not indicate anaphylaxis in many patients |
| Post transfusionb | Variable to FAT, hypervolemia (author experience, unpublished) | Likely immune‐mediated and volume overload, does not indicate anaphylaxis in many patients |
a Conditions that are most important to consider in the acute triage setting of acute collapse and weakness in a previously healthy patient (dog). FAT, flat, and bounce are defined in the text.
b Many posttransfusion cases develop gallbladder wall edema that is not anaphylaxis. Look at your patient and correlate its clinical profile
