of the liver and spleen in 21 dogs and a cat. Vet Radiol Ultrasound 43(3):275–278.4 d’Anjou MA. 2008. Liver. In: Atlas of Small Animal Ultrasonography, edited by Penninck D, D’anjou MA. Ames: Blackwell Publishing, pp 243–247.
5 Fine DM, Olivier NB, Walshaw R, et al. 1998. Surgical correction of late onset Budd–Chiari‐like syndrome in a dog. J Am Vet Med Assoc 212(6):835–837.
6 Hittmair KM, Vielgrader HD, Loupal G. 2001. Ultrasonographic gallbladder wall thickness in cats. Vet Radiol Ultrasound 42:149–155.
7 Kolata RJ, Cornelius LM, Bjorling DE, et al. 1982. Correction of an obstructive lesion of the caudal vena cava in a dog using a temporary intraluminal shunt. Vet Surg 11:100–104.
8 Lisciandro GL, Harvey HJ, Beck KA. 1995. Automobile‐induced obstruction of the caudal vena cava in a dog. J Small Anim Pract 36(8):368–372.
9 Nelson NC, Drost WT, Lerche P, et al. 2010. Noninvasive estimation of central venous pressure in anesthetized dogs by measurement of hepatic venous blood flow velocity and abdominal venous diameter. Vet Radiol Ultrasound 51(3):313–323.
10 Nicoll RG, O’Brien RT, Jackson MW. 1998. Qualitative ultrasonography of the liver in obese cats. Vet Radiol Ultrasound 39(1):47–50.
11 Nyland TG, Mattoon JS, Herrgesell EJ, et al. 2002. Liver. In: Small Animal Diagnostic Ultrasound, 2nd edition, edited by Nyland TC, Mattoon JS. Philadelphia: WB Saunders, pp 93–127.
12 Quantz JE, Miles MS, Reed AL, et al. 2009. Elevation of alanine transaminase and gallbladder wall abnormalities as biomarkers of anaphylaxis in canine hypersensitivity patients. J Vet Emerg Crit Care 19(6):536–544.
13 Spaulding KA. 1993. Ultrasound corner: Gallbladder wall thickness. Vet Radiol Ultrasound 34:270–272.
14 Tsukagoshi T, Ohno K, Tsukamoto A, et al. 2012. Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele. Vet Radiol Ultrasound 53(1):84–91.
Further Reading
1 Harran N, d’Anjou MA, Dunn M, et al. 2011. Gallbladder sludge on ultrasound is predictive of increased liver enzymes and total bilirubin in cats. Can Vet J 52(9):999–1003.
2 Lisciandro GR. 2011. Abdominal and thoracic focused assessment with sonography for trauma, triage and monitoring in small animals. J Vet Emerg Crit Care 21(2):104–122.
3 Lisciandro GR, Lagutchik MS, Mann KA, et al. 2009. Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma. J Vet Emerg Crit Care 19(5):426–437.
Chapter Nine POCUS: Spleen
Stephanie C. Lisciandro and Sarah Young
Introduction
The POCUS examination of the spleen is a valuable diagnostic tool for guiding clinical care and, with adequate care and awareness, can be effectively performed by a nonradiologist veterinarian. The POCUS spleen examination is not meant to replace a complete detailed abdominal ultrasound study by a veterinarian with advanced training (the veterinary radiologist or internist) but rather serves as a screening test for obvious abnormalities. Ultrasonographic findings involving the spleen may be subjective and nonspecific, including splenic size and generalized changes in echogenicity. Additionally, the frequent close anatomical contact of the spleen and liver can make it difficult to differentiate the origin of a mass, particularly for a less experienced sonographer.
As stated in Chapter 8, a concurrent AFAST examination should be performed with any of the POCUS abdominal organ examinations to rule out intraabdominal, retroperitoneal, pleural and pericardial effusions, and in the case of the POCUS spleen examination, to rule out splenic hemorrhage. The AFAST not only detects free peritoneal fluid but also semiquantitates its volume using its abdominal fluid scoring system and assigning an abdominal fluid score (see Chapter 6). The abdominal fluid score helps predict the degree of anticipated anemia in cases of hemoabdomen (Lisciandro 2011; Lisciandro et al. 2009). Global FAST is an even better approach to survey for pleural and pericardial effusion, cardiac and pulmonary abnormalities, and patient volume status. Moreover, Global FAST is used as a screening test to rapidly discriminate between localized versus disseminated disease, comorbidities, and complications, which may be especially helpful in hemoabdomen cases.
What the POCUS Spleen Can Do
Identify focal or multifocal splenic masses or nodules.
Identify parenchymal changes by screening for changes in echogenicity associated with diffuse splenic diseases.
Identify splenic infarction and thrombosis.
Help the clinician to recognize splenic torsion.
These last three goals are inherently more difficult for the novice sonographer and abnormalities should prompt referral for a complete detailed abdominal ultrasound examination.
What the POCUS Spleen Cannot Do
Differentiate benign from malignant splenic masses. The Global FAST approach is a rapid add‐on assessment screening test for localized versus disseminated disease through surveying the abdomen (AFAST), the thorax (TFAST) including heart (TFAST), and lung (Vet BLUE) as well as for detecting other comorbidities.
Definitively diagnose diffuse and localized splenic conditions based on echogenicity.
Reliably determine splenic size (large or small) in dogs (more reliable for size in cats).
Indications
Cranial organomegaly or pendulous abdomen.
Abdominal pain.
Abdominal trauma.
Hematological disorders such as anemia or thrombocytopenia.
Generalized lymphadenopathy.
Episodes of collapse, lethargy or vomiting.
Objectives
Recognize splenic masses (single, multifocal).
Recognize regional and diffuse changes in splenic echogenicity.
Recognize splenic venous congestion, thrombosis, and infarction.
Recognize splenic torsion.
Patient Positioning and Probe Selection
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